Aortopopliteal bypass via obturator foramina for limb salvage after failedprevious iliofemoral, femorofemoral, femoral-popliteal bypasses - A case report

A 65-year-old man with right iliac artery occlusion, left iliofemoral steno sis, and bilateral superficial femoral arteries occlusion, instead of recei ving the traditional aortofemoral bypass, underwent in sequence the followi ng operations: left common iliac to femoral bypass, femorofemoral bypass, a nd bilateral femoropopliteal bypasses with use of polytetrafluoroethylene ( PTFE) grafts. Occlusion of the femoropopliteal bypass and stenosis of the i liofemoral bypass at the distal anastomosis resulted in severe leg ischemia with nonhealing toes and leg ulcers. To minimize ischemia time to the lowe r extremities, pelvic organs, and kidney and avoid the need for multilevel revascularization, the patient received aortobipopliteal bypass via obturat or foramina. The aortic anastomosis was intentionally constructed in and en d-to-side fashion to avert the need for left accessory renal artery implant ation and interruption of the pelvic arterial supply. The patient has palpa ble ankle pulses and progressed to heal the ischemic ulcers following the a ortobipopliteal bypass operation.