[Total revascularization of the lower limb in a patient with multifocal atherosclerosis and critical ischaemia]

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease

Background:

• Multifocal atherosclerosis significantly impacts lower extremity circulation.
• Critical limb ischemia (CLI) with toe necrosis presents a severe clinical challenge.
• Revascularization strategies are crucial for limb salvage in advanced peripheral artery disease.

Observation:

• A male patient presented with multifocal atherosclerosis affecting the iliofemoral segment, superficial femoral artery, popliteal artery, and crus arteries.
• The patient exhibited critical ischemia of the lower limb, complicated by wet necrosis of the toes.
• The clinical presentation indicated a need for urgent and extensive arterial reconstruction.

Findings:

• Successful revascularization of the entire lower extremity arterial bed was achieved.
• Procedures included semiclosed loop endarterectomy using Vollmar rings and autovenous popliteal-tibial bypass.
• Exarticulation of the toes was performed concurrently to manage necrotic tissue.

Implications:

• This case highlights the feasibility of extensive arterial reconstruction in complex lower limb ischemia.
• Combined endarterectomy and bypass grafting can effectively restore perfusion in multifocal disease.
• Aggressive limb salvage strategies are vital for patients with critical ischemia and tissue loss.