If conservative treatments or lumen-widening measures (PTA) do not produce any improvement, the following surgical procedures can – after careful consideration – be used in stages II (only with severe clinical progression), III and IV:

1. Revascularization
   
   
   • Thromboendarterectomy (TEA)
     Enucleation including the vascular intima using a ring stripper for the aortoiliac type + thigh type
     
     
   • Bypass operation
     Vascular replacement with autologous saphenous vein- transplant or alloplastic bypass
     
     
2. Sympathectomy
   
   
   • Lumbar transcutaneous sympathic neurolysis (CT controlled)
     Blockade of vasoconstrictive impulses by means of sympathic denervation, resulting in vasodilatation with increased cutaneous blood supply, indicated with pronounced sympathicotonia
     
     
3. Amputation
   
   
   • Ultima ratio
     in gangrene with the threat of sepsis