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Collateral artery bypass in the infrapopliteal segment

Ai Tochikubo1, Atsuhiro Koya1, Daiki Uchida1

  • 1Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.

Journal of Vascular Surgery Cases and Innovative Techniques
|March 5, 2021
PubMed

Insights

Successful bypass surgery used a collateral artery for a patient with chronic limb-threatening ischemia when standard targets were blocked. This innovative approach offers hope for complex cases of peripheral artery disease.

Area of Science:

  • Vascular surgery
  • Cardiovascular medicine
  • Regenerative medicine

Background:

  • Chronic limb-threatening ischemia (CLTI) poses a significant challenge, particularly in patients with diabetes and end-stage renal failure requiring dialysis.
  • Standard infrapopliteal bypass targets (anterior tibial, posterior tibial, peroneal arteries) are often unsuitable due to severe obstruction or calcification in these high-risk patients.

Observation:

  • A 74-year-old male patient with diabetes and end-stage renal failure presented with gangrene and a heel ulcer, indicative of CLTI.
  • Preoperative assessment revealed complete occlusion or severe calcification in the main infrapopliteal arteries, precluding conventional bypass grafting.

Findings:

  • A successful bypass graft was achieved utilizing a previously undeveloped collateral artery near the posterior tibial artery.
  • This case demonstrates the feasibility and success of collateral artery bypass grafting in the distal infrapopliteal segment for CLTI.

Implications:

  • Collateral artery bypass grafting represents a viable alternative revascularization strategy for CLTI patients with unsuitable traditional targets.
  • This technique may improve limb salvage rates and reduce amputation risk in complex peripheral artery disease cases.

Keywords:
Chronic limb-threatening ischemiaCollateral bypassInfrapopliteal arterial lesions

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