Pharmacological salvage of a combined distal bypass and free flap with catheter-directed thrombolysis.
With recent improvements in microvascular techniques, the use of combined distal bypass and free-flap transfer has been advocated for salvaging the critically ischaemic limb in extreme conditions. Distal bypass, however, carries an inherent risk of graft failure due to thrombosis, and this may threaten the viability of the free flap and, indeed, the lower limb. We present the case of a 66-year-old man with acute-on-chronic ischaemia of his left leg and rectus abdominis free flap. Despite a prolonged ischaemic time of 72 h, both were successfully salvaged using catheter-directed recombinant tissue plasminogen activator. This is previously unreported in the literature.
Parry
D J
DJ
Department of Vascular Surgery, St James's University Teaching Hospital, Leeds, UK.
Byrne
P
P
Kessel
D
D
Robertson
I
I
Patel
J
J
Batchelor
A
A
Scott
D J A
DJ
D000368:Aged; D003925:Diabetic Angiopathies / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000098:blood supply*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator