Distal bypass for chronic limb-threatening ischemia

The patient presented with dry gangrene of the right heel. The aortogram showed good flow through the aortoiliac region bilaterally. The superficial femoral artery on the right is occluded at its origin (arrow; A). Note the presence of an occluded stent in the superficial femoral artery (double arrow; A). The vessel seen adjacent the stent is the deep femoral artery. Flow reconstituted below the knee to the anterior tibial artery (thick arrow; B) and posterior tibial artery (dashed arrow; B), along with the distal third of the peroneal artery (arrowhead; B). Following common femoral artery to posterior tibial artery bypass with reverse great saphenous vein, the wound healed.