Abstract
A 72-year-old man was admitted to our hospital after a new type of coronavirus infection, worsening ischemia of the right lower extremity, and necrosis of the right toes. Contrast-enhanced CT showed occlusion of external iliac artery, superficial femoral artery and popliteal artery, and patency of common femoral artery and posterior tibial artery. Coronary angiography showed severe stenosis of left anterior descending artery (LAD) and circumflex artery (CX). Preoperative ankle brachial pressure index (ABI) was unmeasurable, and skin perfusion pressure (SPP) was highly depressed. Stent grafting of right common iliac artery to external iliac artery and right common femoral artery to posterior tibial artery bypass with a great saphenous vein were performed. After confirming improvement of ABI and SPP, the patient underwent right total toe amputation by plastic surgery. He underwent off-pump coronary artery bypass (left internal thoracic artery to LAD) and percutaneous coronary angioplasty for CX for a two-vessel coronary artery lesion. In the present case, a hybrid technique was selected for both lower extremity and coronary revascularization, and good results were obtained.
https://ror.org/03rq2h425 
