Distal pedal bypass in an the era of endovascular procedures — still worthful and effective treatment option

Abstract

70 years old patient treated for type 2 diabetes mellitus (oral hypoglycemic agents) was admitted to the surgical department of our hospital because of rest pain of his left foot and necrosis of its third toe with underlying purulent inflammation of antetarsum. Computed tomographic angiography revealed typical for diabetes distal pattern of peripheral artery disease with a multilevel stenoses of both tibial and peroneal arteries with only distinct findings in pedal arteries. There was patent femoral and popliteal artery with typical calcification. ABI meassured bilaterally was of 0.62 and in laboratory assignments there was a rise of CRP level, that was 145 mg/l. Because of aferomentioned findings patient was temporally discharged of revascularization and his treatment was diminished to amputation of third toe of his left foot only. His pain resolved and it was obvious it was caused previously mainly by purulent inflammation. However after eight weeks of treatment his wound stayed still unhealed and anergic and then patient was treated surgically. We performed a distal pedal bypass originated in popliteal artery below the knee using inverted saphenous vein harvested in thigh. A runoff artery was posterior tibial artery just below the ankle. After next ten weeks the healing of postoperative wound was almost completed. Its bed was filled up with a granulation tissue and there was prompt epithelization.