[Distal popliteal bypass in the diabetic patient. Clinical case]

Foot revascularization by popliteal-to-distal bypass is a well documented procedure for limb salvage in diabetic patients. The authors report their experience with a diabetic patient admitted with an ischemic left foot [transcutaneous oxygen (PtcO2): 3 mmHg] due to extensive tibial artery occlusive disease beginning at the popliteal artery trifurcation. Limb salvage was achieved by anatomical popliteal-anterior tibial bypass with inverted saphenous vein. Nine months later the patient was readmitted with an ischemic right foot (PtcO2: 16 mmHg) and a similar pattern of peripheral arterial occlusive disease. Limb salvage was achieved by extranatomical popliteal-dorsalis pedis bypass with a reversed saphenous vein. At six months from the latest surgery both feet are healed, PtcO2 is 60 mmHg and 37 mmHg for the left and right foot respectively and the patient has resumed a normal walking distance. This experience, and a review of the literature, confirm the validity of the popliteal-to-distal bypass and the need for more aggressive vascular surgical attitude to treat the ischemic diabetic foot.