Composite femoro-tibial bypass as alternative solution in complicated revascolarization: Case report

Area of Science:

• Vascular Surgery
• Diabetic Complications
• Arterial Reconstruction

Background:

• Peripheral Arterial Disease (PAD) significantly impacts diabetic patients, often requiring complex solutions for long arterial occlusions.
• Redo procedures for bypass in patients with a history of aneurysm repair present unique surgical challenges.
• Critical limb ischemia in diabetic patients necessitates innovative treatment strategies.

Purpose of the Study:

• To describe a case of complicated bypass in a diabetic patient with a history of bilateral popliteal aneurysm.
• To evaluate the efficacy of a composite femoro-anterior tibial artery bypass with angioplasty in a challenging redo-procedure.
• To highlight an alternative surgical approach when autologous vein grafts are unavailable.

Main Methods:

• A 51-year-old male with diabetes, hypertension, and smoking history presented with critical limb ischemia.
• Ultrasound Doppler revealed extensive arterial occlusion, precluding standard autologous vein grafting.
• A composite femoro-anterior tibial artery bypass was performed, coupled with anterior tibial artery angioplasty.

Main Results:

• The composite bypass with angioplasty was successfully performed despite the absence of adequate autologous vein.
• The procedure ensured graft patency and improved distal perfusion.
• The patient's limb salvage was achieved, resolving rest pain and cyanosis.

Conclusions:

• Composite bypasses using synthetic or biologic grafts are viable alternatives when autogenous veins are unavailable in below-knee reconstructions.
• Tibial angioplasty can significantly enhance graft outflow and long-term patency in complex arterial reconstructions.
• This approach offers a safe and effective solution for critically ischemic legs in diabetic patients with limited graft material.