Quaternary revascularization after three failed infra-inguinal bypasses

Abstract

It is becoming increasingly commonplace to find patients with their third or fourth revascularization procedure. We present one such patient with thrice-failed infra-inguinal bypass, which was successfully revascularized. A 63-year-old diabetic, hypertensive with three failed infra-inguinal bypasses presented with forefoot gangrene. Computed tomography angiogram revealed a long-segment occlusion from the external iliac to the middle posterior tibial artery (PT). Hybrid approach was used to stent the proximal anastomotic site and open surgical bypass was carried out for the distal site. The forefoot healed after amputation with skin grafting. Failed infra-inguinal procedures usually present as long-segment, complex lesion, which require a hybrid approach for revascularization. Preoperative planning and reintervention are paramount in achieving suitable patency in this group of patients.

Keywords

• angioplasty
• hybrid
• infra-inguinal bypass
• stenting