Contralateral Femoral Artery as an Inflow Site for Long Distal Bypass Grafting

Abstract

A 68-year-old woman with rest pain in the left foot was transferred to our hospital. She had a history of subarachnoidal hemorrhage with mild permanent disability. The enhanced CT revealed extensive iliofemoropopliteal arterial disease with total occlusion of the common femoral artery and the left deep femoral artery. The left popliteal artery was also occluded below the knee. Only the posterior tibial artery was patent below the ankle. The ipsilateral femoral artery was not available as an inflow site for surgical arterial reconstruction. Long distal bypass to the left ankle was made from contralateral femoral artery for critical limb ischemia. Femoropopliteal crossover bypass was made using a heparin bounded polytetrafluoroethylene (PTFE) graft between the right common femoral artery and the left popliteal artery above the knee. The great saphenous vein was taken from the right leg. The distal bypass was made between the distal portion of the PTFE graft and the left posterior tibial artery at the ankle using the reversed saphenous vein graft in the subcutaneous tunnel. Postoperative angiography showed all the graft were widely patent. The left leg perfusion was dramatically improved after the operation. The patient has been doing well for 12 months since the operation. Long distal bypass from the contralateral femoral artery as an inflow site can be an option for peripheral arterial revascularization in patients who are not suitable for angioplasty or abdominal surgery and where the ipsilateral femoral artery is not available.