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Collateral artery bypass in Buerger's disease: report of a novel procedure
Insights
This case report details a successful collateral arterial bypass for a patient with severe lower extremity arterial occlusion. The procedure utilized the persistent sciatic artery and sural artery, leading to prompt ulcer healing.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Podiatric Medicine
Background:
- Severe lower extremity arterial occlusion can lead to critical limb ischemia and non-healing ulcers.
- Previous surgical interventions, including lumbar sympathectomy and bypass, were unsuccessful in this patient.
- Diffuse arterial occlusion necessitates exploration of alternative revascularization strategies.
Abstract:
A 25-year-old man was admitted to our hospital for treatment of a painful ulcer on his left fourth toe, 9 years after undergoing lumbar sympathectomy and 4 years after undergoing bypass, both of which had been unsuccessful. Angiography demonstrated diffuse arterial occlusion in the lower extremities except for a persistent sciatic artery and a sural artery, which was the main collateral. Thus, reversed bifurcated saphenous vein bypass from the sciatic artery to the sural artery and the posterior tibial artery was performed utilizing Esmarch's rubber bandage as a substitute for a vascular clamp to control bleeding intraoperatively. The ulcer healed promptly and the patient was discharged symptom-free 1 month postoperatively. This case report demonstrates the advantage of performing collateral arterial bypass and illustrates some of the technical challenges associated with this procedure.