Abstract
BackgroundA saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting.Case presentationA 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.ConclusionsWe 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.
Highlights
BackgroundIt is generally recommended that varicose vein grafts not be used, and few prospective case studies have been reported, with evidence insufficient to draw conclusions at this point [1,2,3,4]
A saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting
We successfully treated a patient with lower limb gangrene who received immediate inflow artery reconstruction by endovascular treatment and debridement of a necrotic foot and underwent complete revascularization by bypass surgery using a saphenous vein graft complicated with varicose veins
Summary
It is generally recommended that varicose vein grafts not be used, and few prospective case studies have been reported, with evidence insufficient to draw conclusions at this point [1,2,3,4]. We successfully treated a patient with lower limb gangrene who received immediate inflow artery reconstruction by endovascular treatment and debridement of a necrotic foot and underwent complete revascularization by bypass surgery using a saphenous vein graft complicated with varicose veins. Case presentation An 80-year-old female patient was admitted for severe pain in the left foot She had injured the sole of the left toes a few days before admission, and the area had become ulcerated. A duplex scan showed no flow in the left external iliac artery (EIA) and a poor flow below the left femoral artery We clinically diagnosed her with severely ischemic limbs with sepsis due to foot gangrene. Left femoro-dorsal artery bypass was performed under general anesthesia using the ipsilateral great saphenous vein in a reversed fashion 14 days after admission. Even on follow-up computed tomography (CT), there were no signs of complications, such as occlusion or aneurysm of the varicose vein graft, during the 2-year follow-up period (Fig. 3b)
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