After successful anesthesia, the patient was placed in prone position and routinely disinfected and toweled. An “S”-shaped incision was made in the N fossa of the left lower extremity, about 10 cm long, and the skin and subcutis were incised layer by layer, the fatty tissue in the middle of the N fossa was separated, the N artery was found, and the distal part of the N artery was separated downward to the distal part of the N artery, without pulsation, in the shape of a strip, and a blocking band was applied, taking care not to damage the N vein and tibial nerve. Heparin 40 mg was administered intravenously, and the N artery was incised. The vessel was completely occluded and striated, with no obvious lumen present and no blood flow, and the endothelium was separated and pulled out, with a proximal endothelial length of approximately 20 cm and a distal end of approximately 5 cm, estimated to the distal bifurcation of the N artery. The peeled endothelium was observed to be strip-shaped, approximately 1.8 mm in diameter, and tough. A Fogarty No. 3 embolization catheter was used to remove the embolus to the distal N artery, and no thrombus was removed with good regurgitation. Heparin saline was injected distally to block the distal N artery, and then proximal N artery embolization was performed, and no embolus was removed with no blood spray. Since the lower extremity vessels were slender and there was no matching bypass vessel, it was decided to abandon lower extremity arterial bypass and anastomose the vascular incision with 6-0 vascular suture, observe no bleeding, poke another hole in the wound to place a drainage tube, suture the wound layer by layer, and perform femoral artery endothelial dissection after completion: turn the patient to supine position, re-sterilize the towel. The common femoral artery, superficial femoral artery, and deep femoral artery were dissected out (previous endarterectomy of the femoral artery had made dissection difficult due to severe local adhesions), and the common femoral artery was found to be still pulsating. The common femoral artery was preset with a vascular blocking band, and the superficial femoral artery was incised without blood flow. The endothelium was separated and pulled out, which was about 5 mm long, and the peeled endothelium was observed to be strip-shaped and about 2 mm in diameter. The Fogarty 4 embolization catheter was used to remove the embolus from the distal femoral artery, and it was difficult to pass through, therefore, the middle section of the superficial femoral artery was dissected out by incision in the middle of the thigh, and endothelial stripping was performed in the same way. The whole procedure was a full endothelial stripping until the vessel was patent, and multiple small incisions were made in the superficial femoral artery, and the embolization catheter was inserted from the beginning of the superficial femoral artery to a depth of about 70 cm with good blood return, and 250 ml of 5% sodium bicarbonate was infused intravenously. The incision was anastomosed with a 6-0 vascular suture, and no bleeding was observed. A rubber drainage strip was placed in the thigh wound, and after complete hemostasis, the incision was closed layer by layer after counting the gauze and instruments. The operation went smoothly, but it took a long time and there was not much intraoperative bleeding. After the operation, the patient returned to the hospital room safely. The posterior tibial artery and dorsalis pedis artery of the right limb were not palpated.