Hybrid Lower Extremity Revascularization Avoiding Groin Re-Exploration in a Morbidly Obese Patient With Acute Limb Ischemia After Failed Femoral-Popliteal PTFE Bypass: A Case Report and Literature Review.
Diego Sanchez Calderin, Houssam Farres, Young Erben
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Case in brief
A 69-year-old morbidly obese woman presented with acute left leg pain and numbness but preserved motor function. CTA showed chronic occlusion of the superficial femoral artery and prior femoropopliteal PTFE bypass, with new popliteal thrombosis and loss of tibial runoff. Revascularization used a limited medial thigh incision and a jump PTFE bypass to the posterior tibial artery; retrograde endovascular access through the occluded graft restored proximal flow. There were no postoperative complications. The ankle-brachial index was 0.98, and CTA confirmed bypass patency.
What made this case unusual
The hybrid reconstruction used the previously occluded femoropopliteal graft to restore proximal flow and avoided re-exploration of the previously accessed groin in a morbidly obese patient.
Diagnostic / clinical pearl
In acute limb ischemia with an occluded prior bypass, a limited thigh exposure and retrograde endovascular access through the old graft may enable hybrid revascularization while avoiding groin re-exploration.