ABSTRACT
Indications A composite sequential bypass is indicated in patients with limb-threatening isch
emia in whom there is not a sufficient length of vein to span the femoral tibial segment. Limb-threatening ischemia includes patients with nonhealing ulcers, ischemic rest pain, and gangrene. For infrainguinal bypass, an all-autogenous reconstruction (the greater saphenous vein or splicing veins from upper and lower extremities) functions better than prosthetic grafts. When these options are not available, the composite sequential offers a greater long-term patency than an all-prosthetic bypass.
