2017 Volume 26 Issue 3 Pages 175-178
Critical limb ischemia seems to have occurred due to inappropriate endovascular therapy. An 81-year-old Japanese man underwent bypass surgery and endovascular therapy for Peripheral artery disease at another hospital. He presented with an ulcer on the right second toe. Contrast-enhanced computed tomography showed stent occlusion in the external iliac to common femoral arteries and bypass graft occlusion in the femoral to popliteal arteries. There was hardly any great saphenous vein remaining. We performed a femoro-femoral bypass, a bypass in the right graft to below-knee popliteal with an expanded polytetrafluoroethylene graft (ePTFE). The wound did not heal. Angiography showed occlusion in the right posterior tibial artery. Therefore, we performed a posterior tibial-posterior tibial bypass with saphenous vein graft and amputation of the right second toe. The wound completely healed and the patient was discharged. There is a possibility that stenting on a non-stenting zone produced critical limb ischemia.
