An approach to treatment of infrainguinal graft occlusions

Management of patients with infrainguinal bypass graft occlusions is an inevitable part of all vascular surgery practices. Included within this category are a wide-ranging group of clinical scenarios. Graft occlusions may occur in the immediate postoperative period or years later. The occlusion may result in acute, severe limb-threatening ischemia, or be completely asymptomatic and discovered by accident at the time of examinations for other causes. Despite their fabled objectivity, most surgeons have considerable emotional/ego involvement in their work-their natural response to graft occlusions is nearly always to try to restore patency to the existing system by the most efficient method possible. In the opinion of the authors, this is rarely if ever the correct response.