The femoral-popliteal or distal bypass requires as a rule exact isolation and dissection of the arteriosclerotic and calcified artery. The tourniquet is an effective substitute for vascular occlusion especially in case of seriously calcified vessels. As opposed to the Esmarch bandage, the sterile Löfquist-bandage has a lot of advantages. Starting the bypass operation as usual procedure the Löfquist-bandage can be used for interruption of circulation just before opening the vessels. Positive experiences in varicose vein surgery induced us to perform this tourniquet procedure in distal bypass surgery by using the special Löfquist-bandage. Meanwhile we operated on 74 patients between 1999 and 2003. We treated 29 patients with primary distal bypass reconstruction and 45 patients who suffered from bypass occlusion. In addition to bypass thrombectomy, these patients underwent PTA, reconstructions of the distal anastomosis and bypass prolongations. The advantages were both a short clamping time and an economic dissection of the vessels. The complications were haematomas, re-occlusion, wound infections and major amputations in only few patients. Operative complications with the bandage were not observed. Indications, important technical details and the results are critically discussed.

The creation of a new anastomosis is the preferred method in the treatment of an occluded Cimino shunt. The sole thrombectomy and correction of the venous anastomosis is often insufficient. The most important aspect in cases of occluded PTFE loops is a completely new shunt reconstruction including interposition and over bypass. The need to perform the operations in good time is obvious, but not necessary in every case at night.

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