A Case of Redo Below-Knee Femoro-Popliteal Bypass Utilizing Segmental Patent Saphenous Vein Graft

A 73-year-old man underwent initial below-knee femoro-popliteal bypass (FPBK) using an autologous saphenous vein graft (SVG). Six years later, a sudden leg pain developed in his right lower extremity and an emergency angiography disclosed total occlusion of the external iliac artery as well as SVG. Because sufficient arterial perfusion was not obtained even after emergent thrombectomy, redo FPBK was performed using a synthetic graft. For the distal anastomosis, we reused a segment of the previous patent SVG that had been still open at the distal anastomotic site. After cutting down the SVG at the non-thrombosed part, which was 1cm long from the distal anastomosis, 6mm ringed expanded polytetrafluoroethylene (ePTFE) graft was anastomosed to the stump in an end-to-end fashion. The proximal anastomosis was completed between the ePTFE graft and common femoral artery in an end-to-side fashion. The postoperative angiography demonstrated no stenosis of the distal anastomotic site and no occlusion of previous SVG. In a patient requiring redo FPBK, if previous SVG is not completely thrombosed at the distal anastomotic site, reutilizing the graft is one of the options to complete the redo operation in a safe and simple way. Because the long term patency of this type of composite graft has not been established, further careful observation is needed.