The descending genicular artery as a recipient vessel in chronic limb-threatening ischemia - case report and literature review

ABSTRACT: In recent decades, the increasing complexity of arterial bypasses in the management of chronic limb-threatening ischemia has spurred the development of alternative techniques, such as revascularization of genicular arteries. Few publications on this technique can be found in the literature, and its use has been restricted to specialized vascular groups. This article describes the case of a patient with extensive femorotibial occlusive disease who received a collateral artery bypass, using the deep femoral artery as a donor, the cephalic vein as an alternative autogenous substitute and the descending genicular artery as a recipient. Bypass to the descending genicular artery, although underutilized, is an effective option and increases the possibility of limb salvage in the management of chronic limb-threatening ischemia.

Alternative iliofemoral revascularization in extensive aortoiliac occlusive disease / Revascularização ilíaco-femoral alternativa em doença oclusiva aortoilíaca extensa

ABSTRACT Over recent decades, there has been a considerable increase in use of endovascular methods to treat aortoiliac occlusive disease. It has been demonstrated that this approach offers many benefits, primarily for non-complex arterial lesions of the iliac axis, but difficulties persist with achieving adequate results over the medium and long term when treating extensive occlusive disease. Arterial bypasses to alternative vicarious arteries of the femoral-genicular complex for limb salvage are well known in the literature describing cases that are not favorable for conventional or endovascular surgery. We describe the case of a patient with extensive aortoiliac occlusive disease treated with an arterial bypass in the iliofemoral territory, using an alternative autologous substitute and the descending lateral femoral artery as recipient artery. Alternative bypasses and substitutes that are normally reserved for exceptional cases can and should be part of the vascular therapeutic arsenal and have a contribution to make in cases in which endovascular surgery does not yet enable us to achieve good results.

RESUMO Nas últimas décadas, observou-se o aumento expressivo do tratamento endovascular para a doença oclusiva aortoilíaca. Muitos benefícios foram demonstrados, principalmente nas lesões arteriais não complexas do eixo ilíaco; porém, ainda existe dificuldade na obtenção de resultados adequados a médio e longo prazo quando falamos de doenças oclusivas extensas. As derivações arteriais para artérias vicariantes alternativas do complexo femoro-genicular para salvamento de membro são bem conhecidas na literatura em casos desfavoráveis para cirurgias convencionais ou endovasculares. Descrevemos o caso de um paciente portador de doença oclusiva aortoilíaca extensa tratado com derivação arterial no território ilíaco-femoral, utilizando substituto autógeno alternativo e a artéria descendente femoral lateral como artéria receptora. Derivações e substitutos alternativos, utilizados normalmente em casos de exceção, podem e devem fazer parte do arsenal terapêutico vascular, podendo contribuir nos casos em que a cirurgia endovascular ainda não nos permite alcançar bons resultados.