Extended extraanatomic arterial reconstruction: subclavian artery-bifemoro-crossover-popliteo-tibial-PTFE-bypass

In a high risk patient an extended extraanatomic PTFE (ring armored) bypass was performed for limb salvage. The right subclavian artery served as donor vessel to the left tibial anterior artery in a crossover suprapubic fashion. A total of 7 anastomoses in this subclavian bifemoro-crossover popliteo-crural reconstruction yielded a high flow situation as well as good function with a palpable dorsalis pedis artery pulse and a postoperatively increased ankle-brachial pressure index of 0.9, 8 months postoperatively. During the 9th postoperative month the distal part of the reconstruction occluded and the left leg was amputated below the knee. However, limb salvage was achieved for 9 months. Several points are discussed in connection with long-term functioning.