Ramu, a 40 years old male, a chronic smoker presents with claudication and a medial leg ulcer. For the past one month he is having rest pain. Which of the following procedures would not relieve his rest pain ?

Ans. is 'd' i.e.Femoropopliteal bypass This patient is suffering from Buergers ds (also k/a Thromboangitis obliterans) Buergers ds is characterized by occlusive disease of the small and medium sized aeries* (plantars, tibialis and radial aery), thrombophlebitis of the superficial or deep veins and Raynauds syndrome. As Buergers disease involves the aeries beyond the popliteal aery, there would be no help from a femoropopliteal bypass. It is helpful if the aery is blocked proximally as in atherosclerosis. Not only femoro-popliteal bypass operation but any vascular reconstructive operation is not feasible in Buergers ds, because the involvement of the small vessels of the extremity makes it difficult to locate suitable outflow sites for bypass grafts.