Paramalleolar bypass concomitantly with extended endarterectomy for limb-threatening ischemia: A case report.

A 74-year-old male was admitted to our university hospital with a refractory ulcer of the left third toe. The ankle pressure index was 0.43. On his angiogram, the popliteal artery was totally occluded in the distal site, while the peroneal artery was solely patent and inflowed into the distal posterior tibial artery. At surgery, endarterectomy of 7 cm in length was performed on the tibioperoneal trunk of the occluded popliteal artery following patch repair using a saphenous vein to restore the genicular arterial network and infrapopliteal arteries. Thereafter, the bypass surgery was performed using the in situ saphenous vein from the patent proximal popliteal artery to the distal posterior tibial artery. The postoperative angiogram showed patency of the graft as well as restoration of the genicular arterial network and infrapopliteal arteries. The ankle pressure index improved to 1.04, and the refractory ulcer was completely cured one month after revascularization.