Bilateral Peripheral Arterial Disease.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Bilateral Peripheral Arterial
Disease
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 A 60-years old man presented with rest
pain in both lower limbs mainly on
right side of few months duration. He
was an ex-smoker. Abdominal
aortography and bilateral femoral
angiography revealed total occlusion
of right common iliac artery at its
origin with plenty of collaterals. There
was a faintly opacified profunda
femoris artery. 2

3. The Case…
The right SFA was occluded down
to popliteal artery which was
faintly filled by collaterals. The
distal run off vessels in right leg
were poor. On left side, there was
a lengthy occlusion of SFA with
dense collaterals. The popliteal
artery was visible and reformed
by collaterals. 3

4. 4
Courtesy of Prof. Abdulsalam Y Taha

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Courtesy of Prof. Abdulsalam Y Taha

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Courtesy of Prof. Abdulsalam Y Taha

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Courtesy of Prof. Abdulsalam Y Taha

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Courtesy of Prof. Abdulsalam Y Taha

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Courtesy of Prof. Abdulsalam Y Taha

10. The Case…
 The surgical options offered to the patient
were left femoro-popliteal bypass. But on
the right side, the surgical options were
limited due to lengthy occlusion and poor
distal run off. We thought of exploration of
right femoral artery first and possibly
localized thromboendarterectomy. If this
succeeded, then a graft between abdominal
aorta and right femoral artery might be
possible. Later, one may perform a saphenos
graft between the femoral graft and
popliteal artery. Right lumbar
sympathectomy could also be an option.
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11. Comment
 The angiographic criteria for a bypass
arterial surgery are patent inflow
vessels, segmental occlusion and patent
distal run off vessels.
 Accordingly left femoropopliteal bypass
could be an option for the left lower
limb arterial disease in this patient.
However, the surgical plan was more
complicated on the right side as the
aforementioned criteria were not met.
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