Generally it is necessary to occlude vessels both proximally and distally when arterial reconstruction, endarterectomy, or bypass is being done. In a significant number of instances the application of an occluding clamp to a diseased artery, such as the popliteal or internal carotid, has precipitated a series of technical difficulties culminating in the loss of the repair. This is due to the crushing of an atheromatous plaque by the occluding clamp and subsequent compromise of the lumen of the vessel, either directly by elevation of the plaque or by dissection of blood under the loosened atheroma. When this involves the cerebral vessels, even a small embolic fragment may result in catastrophy.
For the past two years it has been our policy when operating upon smaller arteries, such as superficial femoral, profunda femoris, popliteal, or internal carotid, to avoid the use of a distal occluding clamp when application of a clamp