Staged vascular reconstruction along with repeatedly performed angiographyto prevent ischemic limb loss with Buerger's disease: Report of a case

An aggressive approach to vascular reconstruction should be adopted in pati ents with Buerger's disease and peripheral ischemia who are often young and otherwise active. A patient with severe Buerger's disease is reported who was treated successfully by complete vascular reconstruction with staged by pass surgery while also performing repeated angiography to preserve the foo t function. A 48-year-old man with Buerger's disease presented with necrosi s of the foot. Angiography showed occlusion of the right distal external il iac artery and no runoff below the knee. Repeated angiography after perform ing a lumbar sympathectomy demonstrated patency of the distal portion of th e deep femoral artery. Angiography was again performed after a reconstructi on of the deep femoral artery and patency of the anterior tibial artery was observed. A staged bypass operation on the tibial artery was therefore abl e to achieve a prompt healing of both the toe ulcers and plantar wound.