Year: 2024
Type: article
Study design: Case Report
Abstract: Interval gangrene following a femoral-distal bypass for chronic limb threatening ischemiaAn 85-year-old man presented with rest pain and dry gangrene to his right foot and calf.Clinical examination showed a femoral pulse but no distal pulses.He had a background of coronary artery disease, atrial fibrillation, hypertension, and moderate vascular dementia.An endovascular procedure was attempted first which showed a long occlusion from the second part of the popliteal artery, tibioperoneal trunk, into the proximal posterior tibial artery (PTA) and peroneal artery (Fig. 1).The PTA was patent to the foot, forming the pedal arch.The anterior tibial artery (ATA) had a short patent proximal segment, but completely occluded distally.Endovascular recanalization of the popliteal artery and the PTA was unsuccessful.He underwent a superficial femoral artery to distal PTA (at the ankle) bypass using ipsilateral reversed great saphenous vein.The procedure was technically successful.Post operatively the necrotic shin wound continued to deteriorate, and his surgical incisions had significant skin and soft tissue die-back (Fig. 2).Over 2 weeks, there was full thickness necrosis of his skin, and the subcutaneously tunnelled vein graft became visible.The foot was well perfused, however the leg was ischemic.Transcutaneous oxygen measurements of his foot were 57 mmHg, whereas on his lower leg where the ischemic changes were, they were a maximum of 23 mmHg.Clinically, the diagnosis was interval gangrene.We achieved limb salvage after extensive wound debridement with graft rerouting and muscle flap coverage, followed by a skin graft (Fig. 2).Interval gangrene is a rare complication after successful peripheral vascular restoration with the term first coined in 1991. 1
Source: ANZ Journal of Surgery
DOI: 10.1111/ans.19377
Institution: Townsville Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405729152