Department of Vascular & Endovascular Surgery,Sir Ganga Ram Hospital, New Delhi

Clinical Presentation

• 61 yr old male, chronic smoker

• H/o Rtfemoro-popliteal bypass in 2009, left popliteal balloon angioplasty in 2009 and left femoro-distal bypass in 2012

• Presented with rest pain and right 5th toe gangrene in Sep 2013

• No pulses palpable in rt lower limb

• Femoral pulse palpable in left lower limb

CT ANGIO

• Rt EIA occlusion

• Bilateral SFA occlusion

• Bilateral non-opacification of popliteal arteries

• Poor opacification of b/l ATA/PTA

Procedure Done

• Angiography with endoluminal bypass of right EIA and right popliteal artery done

• Findings :

• Rt EIA total occlusion

• Rtfemoro-popliteal graft occluded

• Rtpopliteal artery segment occluded

• Distally good runoff in peroneal