[A successful cross-over femorotibial bypass for severe ischemic leg of thromboangiitis obliterans].

A case of thromboangiitis obliterans (TAO) successfully treated with a modified vascular reconstruction is reported. A 53 year-old man who had undergone lumber sympathectomy 9 years ago visited our hospital with complaints of rest pain and intractable ulcer at the right big toe. Preoperative angiography could not visualize distal arteries from the right common iliac artery and major amputation above knee was intended. Operative angiography, however, revealed collateral pathways from the posterior tibial artery to plantar arteries. Then, a long bypass from the left common femoral artery to the right posterior tibial artery was made using saphenous vein grafts of both extremities, 75 cm in length. Postoperatively, a solution containing urokinase, PGE1 and heparin was infused continuously for two months through a tube inserted into a branch of the graft. The pain disappeared and the ulcer healed. Now one year after the operation, the bypass graft is patent and the patient is fully rehabilitated. This experience indicates that some of ischemic legs with poor run off due to TAO can be salvaged by such modified vascular reconstruction and postoperative local PGE1 infusion therapy.