COLLATERAL ARTERY BYPASS IN BUERGERS-DISEASE - REPORT OF A NOVEL PROCEDURE

A 25-year-old man was admitted to our hospital for treatment of a pain ful ulcer on his left fourth toe, 9 years after undergoing lumbar symp athectomy and 4 years after undergoing bypass, both of which had been unsuccessful. Angiography demonstrated diffuse arterial occlusion in t he lower extremities except for a persistent sciatic artery and a sura l artery, which was the main collateral. Thus, reversed bifurcated sap henous vein bypass from the sciatic artery to the sural artery and the posterior tibial artery was performed utilizing Esmarch's rubber band age as a substitute for a vascular clamp to control bleeding intraoper atively. The ulcer healed promptly and the patient was discharged symp tom-free 1 month postoperatively. This case report dmonstrates the adv antage of performing collateral arterial bypass and illustrates some o f the technical challenges associated with this procedure.