2022 Volume 31 Issue 3 Pages 113-116
An 85-year-old female underwent lower limb revascularization for highly calcified aorto-iliac severe stenotic disease by right axillo-bifemoral bypass; however, the prosthetic graft became occluded two years later and, thus, femoro–femoral (F–F) bypass with left-sided endovascular therapy for common iliac artery stenosis was performed. Intermittent claudication with lower limb pain at rest developed four years later, and lower limb enhanced computed tomography (CT) revealed the bilateral occlusion of the superficial femoral artery. Left femoro–popliteal bypass for above the knee with a prosthetic graft was initially performed, followed by right lower limb revascularization with an in situ saphenous vein graft (ISSVG) due to the deterioration of right-sided intermittent claudication. Reversed lateral accessary saphenous vein (LASV) was introduced with ISSVG following the effective disruption of the vein valves using a hydrophilic valvulotome, and the proximal blood flow of ISSVG was successfully supplied from the prosthetic graft of F–F bypass to the distal popliteal artery below the knee. Postoperative lower limb enhanced CT indicated the excellent patency and natural features of reversed LASV and ISSVG. This surgical technique has potential as an alternative to ISSVG requiring a greater proximal inflow source of blood for the lower limb when good LASV is achieved.
