Abstract
We report two cases of diabetes mellitus with end-stage renal disease to which we performed additional distal bypass for intractable critical leg ischemia. Case 1 is 64-year-old man was admitted to our hospital with gangrene of the right heel and infection of the surround tissue. Arteries of the right leg and ankle were occluded on angiography while the arteries of the medial malleolus and the dorsal foot were visualized on duplex scanning. Popliteal-to-plantar artery bypass suggested the results of wound infection worsening and the ineffectiveness of debridement sustains ischemia and the hence necessity of reoperation for more blood supply. Thus a bypass was added to a branch of the dorsalis pedis artery. The postoperative course was uneventful and the wound healed. Case 2 was a 72-year-old man admitted with painful left hallux ulcers. On angiography the crural arteries were occluded while the paramalleolar arteries were patent. Popliteal-to-plantar artery bypass was performed but did not relieve ischemia of the foot. Therefore an additional bypass was performed to the dorsalis pedis artery bypass. The postoperative course was uneventful and the symptoms were relieved. Multiple anastomoses might reduce ischemia in intractable cases after distal artery bypass surgery.
