The proximal incision is deepened to expose the common femoral, superficial femoral, and profunda femoris arteries. The region for proximal arterial takeoff of the graft is chosen, and elastic loops are placed about each artery (Figure 3). The proximal saphenous vein is exposed, and 00 silk ligatures are tied about each branch, including the fairly large and constant superficial epigastric, superficial external pudendal, medial and lateral superficial circumflex iliac, and the medial superficial femoral cutaneous veins (see Plate 169, Figure 2). The superficial or Scarpa's fascia of the fossa ovalis is incised to allow complete exposure of the saphenofemoral venous junction. This junction is usually just at the level of the profunda artery. Additional venous length may be needed if the anastomosis is to be proximal on the common femoral artery. This length can be obtained by excising a portion of the anterior common femoral vein in continuity with the saphenous bulb. This technique can also be used to create a larger inflow anastomosis. The common femoral vein is then repaired with a monofilament 6-0 vascular continuous suture. Ordinarily, however, the Satinsky curved vascular clamp is applied to the saphenous side of the junction. A small cuff of saphenous vein is left above the clamp for closure with a running 6-0 monofilament vascular suture such that there will be no constriction of the common femoral vein when the vascular clamp is removed (Figure 4).