Aortopopliteal Bypass Via Obturator Foramina for Limb Salvage After Failed Previous Iliofemoral, Femorofemoral, Femoral-Popliteal Bypasses: A Case Report

A 65-year-old man with right iliac artery occlusion, left iliofemoral stenosis, and bilateral superficial femoral arteries occlusion, instead of receiving the traditional aortofemoral bypass, underwent in sequence the following operations: left common iliac to femoral bypass, femorofemoral bypass, and bilateral femoropopliteal bypasses with use of polytetrafluoroethylene (PTFE) grafts. Occlusion of the femoropopliteal bypass and stenosis of the iliofemoral bypass at the distal anastomosis resulted in severe leg ischemia with nonhealing toes and leg ulcers. To minimize ischemia time to the lower extremities, pelvic organs, and kidney and avoid the need for multilevel revascularization, the patient received aortobipopliteal bypass via obturator foramina. The aortic anastomosis was intentionally constructed in and end-to-side fashion to avert the need for left accessory renal artery implantation and interruption of the pelvic arterial supply. The patient has palpable ankle pulses and progressed to heal the ischemic ulcers following the aortobipopliteal bypass operation.