Peripheral bypass surgery of the lower extremity

The role of peripheral bypass surgery requires redefinition as endovascular techniques evolve. Peripheral bypass surgery remains the treatment of choice for patients with severe claudication or critical ischemia, manifesting as rest pain or tissue loss. Short vascular lesions and/or occlusions can, for the most part, be corrected with endovascular techniques. Longer lesions remain the domain of conventional revascularization, providing there is sufficient influx and run-off to ensure bypass patency. Generally, autologous bypass material is preferable to alloplastic bypass material. This review describes the surgical approach with respect to indication and patient selection, patient preparation, operation technique, and postoperative care.