CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 84-86

Quaternary revascularization after three failed infra-inguinal bypasses


Department of Vascular and Endovascular Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Correspondence Address:
Jithin Jagan Sebastian
Department of Vascular and Endovascular Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_10_20

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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.


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