Abstract
Vein patch angioplasty is a technique sometimes used for distal anastomosis site of below-knee bypass to eliminate compliance mismatch of the artery and prosthetic graft when an autologous vein is unavailable. The usefulness of a vein patch, such as Miller cuff or Linton patch, was previously reported for distal anastomosis site, but a vein patch is not usually used for proximal anastomosis site. In this report, we describe a case of critical limb ischemia in which bypass surgery was performed from the superficial femoral artery to the posterior tibial artery and Linton patch angioplasty was carried out at the proximal anastomosis site.
In general, the ideal arteriotomy length is 1.2- to 2-times longer than the graft diameter, but because of marked diffuse calcification of the artery, the arteriotomy length became approximately 10 mm to make the anastomosis site open and visible. As the graft diameter was as small as 2 mm, direct end-to-side anastomosis resulted in an unfavorable flat shape, necessitating Linton patch closure.
Linton patch angioplasty may be considered even for proximal anastomosis when available veins are limited, and there is mismatch between the arteriotomy length and diameter of the vein graft in infra-popliteal bypass surgery.
