This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
Ramu, a 40 years old male, a chronic smoker presents with claudication and a medial leg ulcer. For the past one month, he is having rest pain. Which of the following procedures would not relieve his rest pain - 
Select and explain. 
A. Lumbar Sympathectomy, B. Omentoplaxy, C. Conservative Amputation, D. Femoropopliteal bypass
D: Femoropopliteal bypass
Answer: D: Femoropopliteal bypass 
Explanation: This patient is suffering from Buergers ds (also k/a Thromboangitis obliterans)
Buergers ds is characterized by occlusive disease of the small and medium-sized arteries* (planters, tibialis and radial artery), thrombophlebitis of the superficial or deep veins and Raynaud's syndrome.
As Buerger's disease involves the arteries beyond the popliteal artery, there would be no help from a femoropopliteal bypass. It is helpful if the artery is blocked proximally as in atherosclerosis.
Not only femoro-popliteal bypass operation but any vascular reconstructive operation is not feasible in Buerger's ds, because the involvement of the small vessels of the extremity makes it difficult to locate suitable outflow sites for bypass grafts.

Treatment of Buergers ds

Stop smoking
Sympathectomy → is used with some success.
Amputation →  is the only way out when gangrene occurs.
Free omental graft → Microvascular transplantation of free omental grafts to areas not
	amenable to arterial reconstruction has been successfully tried.
It appears that conservative amputation should not be used in this pt. who does not have gangrene, but a femoro-popliteal bypass has no role whatsoever and is the better answer out of the two options. Amputation can be used to relieve the patient of persisting rest pain.