Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

•Arterial clamping during femoropopliteal bypass surgery can lead to a stenosis at the clamp site.•There is a significant relationship with the duration of arterial clamping and the occurrence of a stenosis.•Visual assessment of the pre-existing atherosclerotic burden is not a predictor for the occurrence of an arterial stenosis after clamping.•Clamping force appears to play no part in the development of an arterial stenosis.

BackgroundTo date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown.MethodsNinety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inlay clamp and marked with an hemoclip. The number of pre-existing atherosclerotic segments, clamp force, and clamp time were recorded and the occurrence of a stenosis at the clamp site was determined.ResultsAfter a mean follow-up of 83 months, a significant stenosis was confirmed at 23 of the 178 clamp sites (12.9%; 95% confidence interval 8.4 to 18.8). The mean number of pre-existing atherosclerotic segments (P = .28) and the mean clamp force (P = .55) was similar between the groups with and without a stenosis. There was a significant difference regarding clamp time between the group with and without a stenosis (38 minutes and 26 minutes, P = .001).ConclusionArterial clamping, even with the Fogarty-Soft-Inlay clamp, can lead to clamp stenosis and seems to be related to the duration of clamping, but not to pre-existent atherosclerotic burden.