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Pedal Bypass for Critical Limb Ischemia

Vascular Surgery Services, Department of Surgery, Division of Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

Enrico Ascher, M.D.

SUNTY Health Science Center at Brooklyn, Vascular Surgery Services, Maimonides Medical Center, Brooklyn, NY

Peter Gloviczki, M.D.

Mayo Medical School, Chair, Division of Vascular Surgery, Mayo Clinic, Rochester, MN

Audra Noel, M.D.

Division of Vascular Surgery, Mayo Clinic, Rochester, MN

This case panel discussion addresses some of the problems and judgment decisions required in a patient with extensive forefoot gangrene, a stenosis of the superficial femoral artery (SFA), and occlusions of all three leg arteries in the mid and upper leg. With extensive foot debridement to the trans-metatarsal level, balloon angioplasty of the SFA, and a vein bypass to the distal anterior tibial artery, a functional foot remnant was saved. The timing of the various procedures, technical details regarding them, and other issues are discussed.

Key Words: Pedal bypass • foot gangrene • foot ischemia • vein bypass • trans-metatarsal amputation

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 12, No. 2, 131-149 (2000)
DOI: 10.1177/153100350001200223


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