Pedal bypass with deep venous arterialization for acute ischemia in unreconstructable distal arteries patient: A case report

Background: Through acute limb ischemia from thrombosis of angioplasty is low incidence. The result may cause major limb loss, especially in unreconstructable artery. The authors report successful deep venous arterialization bypass in a case of acute limb ischemia from thrombosis of a severe atherosclerotic artery after angioplasty. Case Report: A 67-year-old male suffering from acute left limb ischemia from thrombosis of anterior tibial artery after angioplasty with stent was treated at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. He underwent pedal bypass with deep venous arterialization bypass (DVA bypass) from left superficial femoral artery to left posterior tibial artery. The primary patency was 35 days, and the secondary patency was 6 months. The secondary intention healing of the transmetatarsal amputation wound was 11 months, and the patient was found to be in good condition at 36 months after the operation. Conclusion: DVA bypass in this patient with acute limb ischemia caused by calf vessel thrombosis had low patency. However, this procedure when combined with an endovascular intervention to achieve prolonged patency was shown to be an alternative revascularization treatment for limb salvage in patients with acute limb ischemia in an unreconstructable distal artery.