Interval Skin Necrosis in the Infrapopliteal Segment after Successful Distal Bypass Grafting in a Patient with Chronic Limb-Threatening Ischemia Complicated by Rheumatoid Arthritis Receiving Long-Term Corticosteroid Therapy

Abstract

A 76-year-old woman with rheumatoid arthritis receiving long-term corticosteroid therapy, who underwent bilateral femoro-inframalleolar bypasses, suffered from interval skin necrosis in both lower legs after vein harvest in the contralateral leg and hematoma formation in the ipsilateral leg. Bilateral interval skin necrosis was improved eventually after revascularization for femoropopliteal lesions. In patients receiving long-term corticosteroid therapy who undergo distal bypass surgery, it is essential to address not only foot ischemia but also ischemia in the infrapopliteal region along the graft route and at the vein harvest site when formulating the surgical strategy.