The main age of onset of smoky disease is concentrated in children under 10 years of age and adults around 40 years of age, showing a typical bimodal distribution. Of course, the disease also occurs in other age groups, but the number is small. For example, people in their twenties and thirties can also develop smog, and we have even encountered patients with smog at the age of 60 in clinical practice. Some patients ask if they can have surgery for smog at the age of 60. In fact, there is no direct relationship between the implementation of smog surgery and age, and older age is not a contraindication to surgery, as long as the physical condition is up to standard and all indicators meet the surgical criteria, 60-year-old smog patients can also undergo surgery. For the treatment of smog, it is generally accepted that conservative medical treatment is basically of little significance, and surgery should be performed as soon as the diagnosis is clear. However, it is important to choose carefully which surgical procedure to use. Traditionally, direct vascular bypass or indirect vascular bypass surgery (i.e., patching) has been used to treat smog, but both approaches have their limitations and drawbacks. For example, direct vascular bypass surgery is more difficult and the scope of blood supply improvement is limited, while patching surgery takes 3-6 months to form neovascularization, during which cerebral infarction and cerebral hemorrhage may still occur. Therefore, neither the direct bypass surgery nor the patching surgery alone can achieve very satisfactory results. There is a new type of surgery, combined vascular bypass surgery, which overcomes the above disadvantages and achieves the ideal results. Combined vascular bypass surgery is done by combining direct bypass and patching in the same surgery, and while direct bypass immediately achieves blood flow, multi-factor patching is performed to expand the scope of blood supply improvement and achieve better results.