title: Collateral artery bypass in Buerger's disease: report of a novel procedure.
abstract: A 25-year-old man was admitted to our hospital for treatment of a painful ulcer on his left fourth toe, 9 years after undergoing lumbar sympathectomy and 4 years after undergoing bypass, both of which had been unsuccessful. Angiography demonstrated diffuse arterial occlusion in the lower extremities except for a persistent sciatic artery and a sural artery, which was the main collateral. Thus, reversed bifurcated saphenous vein bypass from the sciatic artery to the sural artery and the posterior tibial artery was performed utilizing Esmarch's rubber bandage as a substitute for a vascular clamp to control bleeding intraoperatively. The ulcer healed promptly and the patient was discharged symptom-free 1 month postoperatively. This case report demonstrates the advantage of performing collateral arterial bypass and illustrates some of the technical challenges associated with this procedure.
authors.affiliation: Second Department of Surgery, Yamanashi Medical University, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Shindo
authors.forename: K
authors.initials: K
authors.lastname: Kamiya
authors.forename: O
authors.initials: O
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Tada
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001458:Bandages; D003097:Collateral Circulation; D016523:Foot Ulcer / Q000209:etiology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation*; D013919:Thromboangiitis Obliterans / Q000150:complications / Q000601:surgery*; D016909:Tibial Arteries / Q000601:surgery; D014034:Toes