Hybrid DVA on the superficial dorsal system. TUTORIAL VIDEO
72yo male, NKA, former heavy smoker. Atrial fibrillation, COPD, CKD. Under long-term corticosteroid therapy.
The patient was admitted with a necrotic ulcer on the 2nd toe of the right foot (W2I3FI1). He had undergone a prior BTK recanalization attempt (PTA and peroneal artery angioplasty) without any success on reaching the BTA vessels. MAC score 5.
On physical examination: No pulses below the knee bilaterally. ABI non compressible. TCPO2 21mmHg.
It was considered a no-option patient and therefore we decided to perform a hybrid DVA on the superficial dorsal system.
Since the GSV below the knee had an inadequate caliber, we performed a variation of Lengua´s technique using the GSV of the thigh. The proximal anastomosis of the bypass was on the P3 segment (side to end) and the distal one on the distal GSV (4cm above the ankle (end to end)).
Finally the medial marginal vein was dilated with a 4mm balloon in order to destroy the venous valves. Following R. Ferraresi´s theory (scape from the fortress), we also drained the MMV on the first toe main vein (3mm balloon angioplasty).