Deep Circumflex Iliac Artery as an Inflow Alternative for Surgical Revascularization: A Case Report

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease Management

Background:

• Common femoral artery (CFA) is the standard inflow for surgical revascularization in peripheral artery disease (PAD).
• CFA accessibility can be compromised by calcification, obstruction, or prior dissection, necessitating alternative inflow sources.

Observation:

• A 62-year-old male presented with chronic limb-threatening ischemia, including toe necrosis and rest pain.
• Computed tomography revealed severe stenosis in the CFA, superficial femoral artery, deep femoral artery, and a fully stented external iliac artery.
• The deep circumflex iliac artery (DCIA) was identified as the sole patent artery suitable for inflow.

Findings:

• Deep circumflex iliac artery (DCIA) was successfully utilized as an inflow source for surgical revascularization.
• A deep circumflex iliac artery-to-popliteal artery bypass was performed using a saphenous vein graft.
• The bypass graft remained patent at 9 months post-surgery, confirming successful revascularization.

Implications:

• This case demonstrates the feasibility of DCIA as an alternative inflow for complex lower extremity revascularization when standard options are unavailable.
• Successful limb salvage was achieved, highlighting the importance of identifying and utilizing alternative arterial sources in critical limb ischemia.
• This approach may offer a viable option for patients with extensive iliofemoral disease, expanding treatment possibilities for PAD.