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Tibial artery autogenous in situ vein bypass with adjunctive arteriovenous fistula
1Department of Surgery II, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Insights
This study presents a successful femoro-tibio-peroneal trunk autogenous vein bypass with an arteriovenous fistula for severe intermittent claudication. The procedure significantly improved walking distance and arterial blood flow in the affected limb.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Severe intermittent claudication significantly impairs quality of life.
- Extensive popliteotibial artery occlusion presents surgical challenges due to poor distal run-off.
Observation:
- A patient with severe right calf and foot claudication was unable to walk over 50 meters.
- Preoperative arteriography showed extensive arterial occlusion, deeming conventional surgery unfeasible.
Findings:
- Successful in-situ autogenous vein bypass from the superficial femoral artery to the tibio-peroneal trunk was performed.
- An adjunctive arteriovenous fistula was created, improving ankle pressure index from 0 to 0.65.
- Postoperative Doppler confirmed improved blood flow, enabling the patient to walk over 1,500 meters.
Implications:
- This surgical technique offers a viable solution for complex femoro-tibio-peroneal occlusive disease.
- Improved limb perfusion and functional capacity can be achieved in patients with critical limb ischemia.
- The adjunctive arteriovenous fistula enhances bypass graft patency and distal flow restoration.
Abstract:
A man suffering from severe intermittent claudication of the right calf and foot was successfully treated by femoro-tibio-peroneal trunk autogenous vein bypass with adjunctive arteriovenous fistula. Prior to operation, he was unable to walk more than 50 meters without resting. Preoperative arteriography revealed extensive occlusion of the popliteotibial arteries, except for indistinct visualization of the tibio-peroneal trunk, in which conventional reconstructive surgery seemed not to be feasible because of poor distal run-off. An autogenous vein bypass graft between the distal superficial femoral artery and tibio-peroneal trunk was successfully made "in-situ", creating an adjunctive arteriovenous fistula. Postoperatively, the ankle pressure index of the posterior tibial artery was considerably increased from 0 to 0.65, and Doppler flow wave could be recorded. The patient can now walk more than 1,500 meters without resting.