Remembering an Old Technique: Retroscrotal Perineal Femorofemoral Bypass for Ischaemic Ulcer of the Anterior Thigh

Abstract

A 61 year old male (after multiple previous bilateral peripheral arterial procedures and fenestrated endovascular aortic aneurysm repair) consulted for buttock claudication and ischaemic ulceration of the anterior right thigh. Computed tomography angiography showed patent common and external iliac arteries, common and superficial femoral arteries (previously stented), and occlusions of right internal iliac, deep circumflex iliac, and proximal deep femoral arteries. After failed endovascular attempts, a femorofemoral crossover bypass was performed using a cryopreserved venous allograft. Owing to ischaemic necrosis of the thigh, perineal retroscrotal tunnelling was preferred. Dual antiplatelet therapy was initiated post-operatively. Tunnelling in this lesser known region allowed successful wound healing after several months.Image 1