To the Editor.—Faro et al described an ingenious technique to restore flow into a severely diseased profunda femoris artery and to maintain the patency of the aortofemoral limb of a bypass (Archives 1980;115:1111-1115). I submit, however, that an extensive profunda endarterectomy followed by the extension of the limb of the aortofemoral bypass over the endarterectomized segment is a highly acceptable technique for dealing with the problem. Such a technique is no more hazardous, and it does not expose the outflow to any more endarterectomized artery than does the eversion technique of the superficial femoral artery. In addition, it opens those branches down to the point that an acceptable profunda lumen is reached.
I find it difficult to conceptualize the relationship of the described superficial femoral eversion endarterectomy and profunda anastomosis in maintaining patency of aortoiliac endarterectomies.
Failures of aortoiliac endarterectomy occur for many reasons, but most vascular surgeons believe