[Pedal bypass using venous allograft]. / Pedální bypass s pouzitím allogenní zilní náhrady.

INTRODUCTION: Pedal or distal crural bypass surgery for limb salvage is a method with very good long-term results. For patients in whom a suitable autologous venous graft is not available, the use of a venous allograft is an alternative procedure. CASE REPORT: A 68 years old man with ischaemic disease of lower extremities and gangrene of the left foot was admitted to our Centre in August 2014. He underwent percutaneous transluminal angioplasty of crural arteries of his left lower extremity. This, however, failed to improve peripheral circulation. The patient was then indicated for pedal or distal crural vascular reconstruction. Since no suitable autologous vein was available, distal bypass surgery using a donor graft remained the only option for limb salvage. Amputation of the toes on the left foot due to gangrene was necessary. Subsequently, femoro-pedal bypass to the left common plantar artery was performed using a great saphenous vein allograft. The post-operative course was without complications, the pedal bypass was patent and toe amputation was with good healing. The patient remained in follow-up care. CONCLUSION: A good outcome of vascular reconstruction with an allograft depends on the availability of a suitable allograft and good patient compliance with post-operative care. In the case presented here, the pedal bypass grafting by means of an allograft helped to save the patients limb. KEY WORDS: pedal bypass venous allograft limb salvage.

[A rare case of a long-term patent axillobipopliteal bypass--a case report]. / Ojedinelý prípad dlouhodobé pruchodnosti axillo-bipopliteálniho bypassu--kazuistika.

INTRODUCTION: One of the options for the treatment of vascular graft infection in the aortoiliofemoral region is its explantation and extra-anatomical reconstruction. The authors present a rare case of a long-term patent axillobipopliteal bypass. CASE REPORT: A polymorbid patient with complete infection of the aortobifemoral prosthetic graft, with abscess in the groin and bilateral occlusion of the superficial femoral artery was treated by complete graft explantation and implantation of extra-anatomical axillobipopliteal bypass. The occlusion of the distal part of the left limb of the graft after 6 years was successfully solved by reoperation replacement with a new vascular prosthesis. DISCUSSION: The advantage of the extra-anatomical axillo(bi)femoral/popliteal reconstruction is its usability in urgent conditions. However, this reconstruction is associated with a high risk of graft thrombosis because of the length of the graft. Currently, we prefer an autogenous femoral vein for the treatment of the graft infection in the aortoiliofemoral region. CONCLUSION: Although the long-term results of the axillo(bi)femoral/popliteal reconstructions are generally not favourable, the secondary patency of the extra-anatomical bypass in presented patient is maintained for more than 6 years.