Distal bypass with a varicose vein graft for critical limb ischemia: report of a case

Abstract

Background: A saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting.

Case presentation: A patient who developed sepsis due to lower limb gangrene was successfully treated by endovascular treatment and bypass surgery using a varicose vein graft. There were no complications, such as occlusion or aneurysm, of the varicose vein graft during the 2-year follow-up period.

Conclusions: We herein report a case in which bypass surgery with a varicose vein graft was used to avoid major amputation of the lower limb, and the patient recovered markedly from sepsis. If there are no other appropriate autologous veins for revascularization of lower limb gangrene, a varicose vein graft may be useful as a conduit for bypass surgery at risk of graft infection.

Keywords: Bypass surgery; Critical limb ischemia; Limb salvage; Varicose vein.

Fig. 1

The picture on admission showed that the left foot was swollen red, and the first toe was gangrenous

Fig. 2

The stump became gradually necrotic after metatarsal amputation (a). Preoperative plain computed tomography showed that the left great saphenous vein was complicated with varicose veins (arrowheads) with thin vessel walls (arrow) (b)

Fig. 3

The stump of the amputated toes completely healed (a, 6 months after the bypass surgery). Follow-up contrast-enhanced computed tomography revealed that there were no complications, such as occlusion or aneurysm, of the varicose vein graft (b)