Tuğra GENÇPINAR, Çağatay BİLEN, Gökmen AKKAYA, Deniz SEREFLİ, Öztekin OTO

The role of computed tomography angiography for popliteotibial bypass: a successful limb salvage procedure

Bu yazıda, popliteotibial segmentin aterosklerotik tıkanması nedeniyle kritik iskemili 64 yaşında erkek bir olgunun başarılı cerrahi tedavisi sunuldu. Konvansiyonel anjiyografide distal açıklık olmaksızın, total popliteal oklüzyon izlendi. Tekrarlanan bilgisayarlı tomografi anjiyografide anterior tibial arter ve peroneal arterde zayıf distal akım ve posterior tibial arterde proksimal ciddi darlık saptandı. Ekstremitenin kurtarılması için antibiyotik tedavisi ile tersine çevrilmiş büyük safen ven kullanılarak, popliteodistal baypas yapıldı. Bu olgu nadir olması ve karar verme zorluğu açısından sunuldu

Popliteotibial baypasta bilgisayarlı tomografi anjiyografinin rolü: Başarılı bir ekstremite kurtarma işlemi

Herein, we present a successful surgical treatment of a 64-year-old male patient with critical ischemia due to atherosclerotic occlusion of the popliteotibial segment. Conventional angiography revealed total popliteal occlusion without distal run-off. Repeated computed tomography angiography showed poor distal flow of the anterior tibial artery and peroneal artery and proximal severe stenosis of the posterior tibial artery. Popliteodistal bypass using a reversed great saphenous vein was performed with antibiotherapy for limb salvage. We present this case for its rarity and difficulty in decision-making

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Gargiulo NJ, Veith FJ, O'Connor DJ, Lipsitz EC, Suggs WD, Scher LA. Experience with a modified composite sequential bypass technique for limb-threatening ischemia. Ann Vasc Surg 2010;24:1000-4.
Galaria II, Surowiec SM, Tanski WJ, Fegley AJ, Rhodes JM, Illig KA, et al. Popliteal-to-distal bypass: identifying risk factors associated with limb loss and graft failure. Vasc Endovascular Surg 2005;39:393-400.
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007;33:1-75.
Woo K, Palmer OP, Weaver FA, Rowe VL. Use of completion imaging during infrainguinal bypass in the Vascular Quality Initiative. J Vasc Surg 2015;61:1258-63.
Conte MS, Pomposelli FB. Society for Vascular Surgery Practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication. Introduction. J Vasc Surg 2015;61:1.
Kazakov II, Lukin IB. Choosing the method of reconstructive operation in patients with atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. Angiol Sosud Khir 2014;20:135-40.
Tsuji Y, Shiraki T, Iida O, Tsuji Y, Kitano I, Sugimoto K, et al. Impact of infrapopliteal endovascular treatment on the outcome of subsequent ipsilateral distal bypass for critical limb ischemia. J Cardiovasc Surg (Torino) 2015 Sep 23. [Epub ahead of print]
Gulati A, Botnaru I, Garcia LA. Critical limb ischemia and its treatments: a review. J Cardiovasc Surg (Torino) 2015;56:775-85.
Ziza V, Canaud L, Gandet T, Molinari N, Alonso W, Chastan R, et al. Outcomes of cold-stored venous allograft for below- knee bypasses in patients with critical limb ischemia. J Vasc Surg 2015;62:974-83.