Successful bilateral popliteal-plantar bypasses for polyarteritis nodosa induced ischemia

Polyarteritis nodosa (PAN) is a rare vasculitis that can cause peripheral ischemia. We present the case of a 49-year-old man who developed PAN causing toe gangrene and severe rest pain in one foot and claudication of the contralateral foot. He was treated with immunosuppression and underwent popliteal-plantar artery bypass with resolution of rest pain and subsequent amputation of his mummified toe. Despite remission of PAN, his contralateral foot claudication was lifestyle limiting; thus, 5 years later he underwent contralateral popliteal-plantar bypass with resolution of claudication. This case demonstrates the anatomically symmetric presentation of PAN induced ischemia with successful open revascularization after resolution of inflammatory markers with systemic therapy.