Smoke disease is a relatively rare cerebrovascular disease, mainly due to chronic progressive stenosis or occlusion of the major bilateral branches of the cerebral arterial ring (the siphon segment of the internal carotid artery, the anterior cerebral artery, the middle cerebral artery, and sometimes the beginning of the posterior cerebral artery), followed by the emergence of a network of small abnormal side branches. Such a network of small vessels appears as a dense pile of small vessels on cerebral angiography, resembling the smoke exhaled during smoking, hence the name smoker’s disease. Smoke disease is a very dangerous disease that can cause cerebral infarction or cerebral hemorrhage at any time. Sometimes the attack can be very sudden, such as headache and weakness, limb movement disorder, etc., and in serious cases, it can be disabling and fatal. Therefore, once smog is detected, it should be treated promptly. For the treatment of smog disease, the medical community basically recognizes that conservative treatment is not very effective, and can only provide some relief in the early stage, but the later stage is not effective; therefore, once smog disease is clearly diagnosed, surgery should be performed as soon as possible. The traditional surgical treatment of smog is mainly direct vascular bypass and patching. However, whether direct bypass or patching is performed, there are certain limitations and drawbacks to achieve the desired effect. For example, direct bypass has limited scope to improve blood supply, while patching requires 3-6 months to take effect, during which time there is still the possibility of danger. So what is the latest procedure for smog in 2018? A new combined vascular bypass surgery is now clinically available to overcome these disadvantages. Combined vascular bypass surgery is a composite procedure, where direct bypass and patching are done in the same surgery, allowing a two-pronged approach to achieve a more desirable result by both rapid blood passage and continued expansion of blood supply improvement.