Ying-Sheng Li*, Yu-Chieh Lu
Background: Acute limb ischemia is a serious condition even in an era of highly comprehensive medical treatment. Despite the development of conservative and endovascular treatment, complete removal of the thrombus with antegrade thrombectomy via the femoral approach, especially in below-the-knee arteries, is still not possible. In addition, distal embolization of dislodged debris or thrombus during the procedure is another concern as this might cause severe complications, including amputation. Given the above-mentioned issues, retrograde surgical cut-down direct thrombectomy from the dorsalis pedis artery and posterior tibial artery could be an optimal option for complete revascularization in below-the-knee arteries.
Case presentation: We present one case where the limb was preserved after retrograde surgical thrombectomy. The standard antegrade thrombectomy procedure with a conventional surgical approach from the common femoral artery was performed. The patient underwent an intraoperative assessment of indications for dorsalis pedis artery and posterior tibial artery retrograde thrombectomy by the surgical cut-down method. After retrograde thrombectomy, direct evaluation of blood flow was the strongest evidence of revascularization. A retrograde angiogram showed revascularization of below-the-knee arteries. The patient had successful salvage procedures that prevented major limb amputation.
Conclusion: Retrograde surgical thrombectomy could be a salvage procedure for incomplete antegrade thrombectomy.