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Related Experiment Video

Updated: Nov 15, 2025

Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound

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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

Summary

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.

Keywords:

Chronic limb-threatening ischemia Collateral bypass Infrapopliteal arterial lesions

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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.