"Spoon bowl" deformity of proximal femoral bypass vein graft: a cause of late graft failure on four occasions.

We cite four examples of splaying of the proximal end of femoral bypass vein grafts accompanied by graft stenosis as a cause for late postoperative recurrent ischemic symptoms or graft failure. Though usually associated with dilation of the common femoral artery, one patient showed no arterial aneurysm. After appropriate angiographic views to demonstrate the "spoon bowl" deformity, corrective surgery to widen or bypass the stenotic segment and prevent further dilation of the artery, where indicated, resulted in patent grafts in all patients for at least one year. Diminishing pulses or the recurrence of ischemic symptoms after femoral bypass vein graft are indications for angiography of the graft. This should include appropriate views to demonstrate the proximal anastomosis that may show a "spoon bowl" deformity amenable to surgical correction.