Venous bypass
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In this patient necrosis has occurred because of obliteration of an artery at the level of the knee. To prevent even more necrosis it is decided to perform a limb salvage operation by means of a venous bypass. A vein at the inner side of the leg is removed and prepared for the bypass.
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Angiografy shows a fairly normal system in the pelvis and the groin(2,3). In the groin the connection of the bypass will be performed. In the upper leg obstructions begin and at the level of the knee no normal vessels can be seen anymore. Tiny rescuevessels (collaterals) develop to transport the blood to the lower leg. The amount of blood will however be insufficient in case of (heavy) fysical exercise(4-6). In the lower leg there is only one reasonble vessel(6). This will be used to connect the bypass to.
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The inner side of the leg shows the wound where the vein that is used for the bypass is removed (7). An oversight of the outer side of the leg with the several necessary wounds (8), after connection to the lower leg (9) and the details of this connection when it was being made (10,11). There is a large difference in the diameter of the bypass and the original vessel.
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Here one can see the wound in the groin and the pull through of the bypassvein(12,13). Then the connection in the groin is made (14,15).
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The situation after the bypass with the several wounds and the subcutaneous placement of the bypass(17). In a second stage the necrotic tissue will have to be removed.