THE ASSOCIATION of aorto-iliac arteriosclerotic occlusive disease and more distal occlusion of the superficial femoral artery is not an unusual finding in patients with ischemic symptoms involving the lower extremities. Fortunately, relief or major improvement can usually be achieved by bringing good arterial flow down to the profunda femoris either by aorto-iliac endarterectomy or by bypass grafting. At the Roosevelt Hospital, our procedure of choice has been bypass grafting with woven or knitted Dacron bifurcation grafts from the aorta to either the iliac or common femoral arteries, depending on the extent and location of the occlusive disease. This is accompanied, when necessary, by endarterectomy of the common femoral artery and the orifice of the profunda femoris. A bilateral lumbar sympathectomy is always done at the same time.
Unfortunately, in some patients the correction of the aorto-iliac obstruction does not relieve the symptoms due to the extent of the arteriosclerotic changes