[Distal crural bypass as a limb salvage procedure--case report]

The authors present a case of a patient with a progredient moist gangrene of the right foot. In this patient, amputation of the lower limb was indicated because of an unfavourable angiographic finding, after unsuccessful conservative treatment. With regard to the fact, that the patient had undergone amputation of the other lower limb in the crus, revision of the posterior tibial artery was decided. Preoperative angiography did not confirm the previous unfavourable angiographic finding. After the implantation of a distal crural venous bypass (posterior tibial artery--supramalleolar part), healing of the extremity occurred in a relatively short time period. The authors agree with the opinion that distal crural and pedal bypasses cannot be always indicated on the basis of routinely performed angiography. Revision of crural arteries and possible preoperative angiography can change the situation and lead to the salvage of the limb.