Rare Case of Complex Bifurcation Stenting in a Patient of below Knee Acute Limb Ischemia

Background: Peripheral arterial disease (PAD) is one of the well-recognized chronic vascular conditions characterized by the compromised blood circulation to the extremities. PAD is due to deposition of cholesterol, calcium associated with endothelial dysfunction. PAD is common in patients suffering from type 2 Diabetes Mellitus and chronic kidney disease. It’s very severe stage, coined as acute limb ischemia (ALI) which is described as the acute ischemic rest pain in the lower extremity, ulceration or gangrene and finally leading to the risk of losing limb and sometimes mortality. The various revascularization approaches are used for the treatment of ALI out of which complex bifurcation stenting is a rarely used method. This is the first report on the utilization of a particular method against below knee limb ischemia.

Method: A 50-year-old male presented with severe right side leg pain one day with bluish discoloration in the right foot. The history of the patient was very limited due to severe discomfort during admission, he specified that his right leg felt as it was ‘‘on ice’ ‘Patient was quickly diagnosed to have acute limb ischemia. Initial Doppler examination of the right lower limb showed an occluded lower part of the popliteal artery and tibio-peroneal trunk. Patient was quickly taken for peripheral angiogram followed by a unique complex first time described bifurcation Culottes stenting for peripheral vascular disease. Post patient improved immediately. Both limbs and life were saved.

Discussion: ALI (Acute limb ischemia) is a life-threatening situation. Occluded vessels if not treated on time can lead to gangrene and sometimes mortality. Previously, the use of coronary stents for angioplasty has been rarely described. The present study on the use of bifurcation stenting techniques showed a positive impact on the anatomy as well as physiology of the coronary arteries. Moreover, this case study also exhibited that the culottes bifurcation technique is the best way for the management of below knee acute limb ischemia.