Abstract
The patient was a 51-year-old woman with systemic lupus erythematosus and renal failure undergoing hemodialysis. She developed gangrene of the left leg and endovascular therapy to the anterior tibial artery and peroneal artery had been performed at a different hospital. However, the leg did not cured. It was suggested that she undergo below-knee amputation of the left leg. She hoped that she could be treated at a hospital near her home, so she visited our hospital. Preoperative angiogram showed that the anterior tibial artery was observed to be patent but the area of posterior tibial artery flow was very limited. The value of skin perfusion pressure was low in the plantar region. Left below-knee popliteal-posterior tibial artery bypass with reversed autovein graft and amputation of left metatarsal bones were performed. After the surgery, there was extensive formation of granulation tissue at the edge of the amputation area. To prevent the occlusion of the graft, we administered heparin by drip infusion, but the graft was occluded on the 7th postoperative day. We performed angiography on the 14th postoperative day, and found that the graft was occluded. We therefore used a multidisciplinary approach; endovascular therapy at the anterior tibial artery, vacuum-assisted closure therapy, and split thickness skin grafting, and we were able to avoid major amputation.
