A Case of a Mixed Arterial Venous Leg Ulcer Associated with Incomplete Residual Sciatic Artery Successfully Treated with Sciatic Artery-anterior Tibial Artery Bypass

Abstract

One patient with a mixed arterial venous leg ulcer of the lower leg caused by an incomplete residual sciatic artery underwent distal sciatic artery-anterior tibial artery bypass surgery using an arteriovenous fistula and dilated upper extremity vein with excellent results. A 65-year-old male patient developed a right leg ulcer after a permanent inferior vena cava filter was placed 20 years ago for the diagnosis of deep vein thrombosis in the right lower extremity. The ulcer was diagnosed as a congestive dermatitis and the patient was treated with varicose vein therapy and compression therapy over a long period of time, but the ulcer did not improve. Considering the possibility of a mixed arterial venous leg ulcer due to incomplete residual sciatic artery and arteriosclerosis obliterans, surgery was performed. The superficial veins of the lower extremities were obliterated by treatment of varicose veins, and veins from the upper extremities were used as autologous vein grafts. An arteriovenous fistula was created in the forearm and the vein was dilated and grafted. The ulcer healed after the operation.