Editing Fem-pop occlusive disease (section)

=== Surgical treatment ===

* Factors required for bypass
** Adequate inflow site
*** Choice based on examination/USS, but needs to be confirmed with angio
*** Address haemodynamically-significant lesions prior to bypass
*** Most common choice in fem-pop bypass is CFA
**** If significantly diseased, consider CFA endarterectomy
*** PFA or SFA are alternative inflow sources
** Adequate outflow site
*** Ideally: normal in calibre, free of stenosis, in continuity with at least one of the arteries supplying the foot
*** Below-knee popliteal is best. If that's occluded, best bet is tibial artery with best foot runoff
*** Can consider ulcer locations sometimes (angiosome theory)
** Adequate conduit (best is great saphenous vein - no sclerosis, at least 3mm in diameter)
*** Vein mapping - diameter, compressibility, wall thickness, flow
*** GSV preferred, otherwise use cephalic/basilic/small saphenous
*** GSV should be reversed, but can also be done in situ
*** Prosthetic is last resort - PTFE. Improved patency rates by using an adjunctive vein cuff (Miller or St Mary's) or Taylor patch
***
* If these are not present, endarterectomy/profundoplasty might be a better alternative
* Surgery remains best option for patients with ischaemic rest pain or tissue loss.