{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:55:09Z","timestamp":1791442509251,"version":"4.3.3"},"reference-count":25,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We present a case of acute limb ischemia (ALI) in a morbidly obese patient with prior femoro-popliteal artery PTFE bypass occlusion successfully treated with a hybrid femoral-to-posterior tibial artery bypass utilizing the previously occluded graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>A 69-year-old morbidly obese woman presented with acute left leg pain and numbness with preserved motor function. Computed tomography angiography (CTA) demonstrates chronic superficial femoral artery and femoro-popliteal PTFE bypass occlusion with a new native popliteal artery thrombosis and loss of tibial runoffs. After systemic heparinization, the leg was revascularized through a small medial thigh incision and a jump PTFE bypass to the posterior tibial artery. The previously occluded femoro-popliteal artery bypass was accessed to re-establish proximal flow through a retrograde endovascular construction using a 7\u00a0mm by 25\u00a0cm Viabahn (Gore, Flagstaff, AZ) stent. This stent was used as a bridge with distal deployment within a new 6\u00a0mm PTFE graft, which was then anastomosed in an end to side fashion to a Linton patch of the posterior tibial artery. There were no postoperative complications, and the ankle-brachial-index was measured to be 0.98 with a CTA with runoffs confirming bypass patency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>ALI in the setting of a prior bypass occlusion in a morbidly obese patient reflects the typical contemporary patient and disease complexity, which demands corrective revascularization with appropriate mitigation\/prevention of other postoperative complications. A limited thigh exposure to access a previously occluded bypass can successfully restore in-line flow in these high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hybrid lower extremity revascularization is an alternative surgical modality to restore in-line flow to a lower extremity as a limb salvage option while avoiding groin re-exploration in a previously accessed groin for bypass construction in a morbidly obese patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15385744261455561","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:54:28Z","timestamp":1779530068000},"page":"712-719","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid Lower Extremity Revascularization Avoiding Groin Re-Exploration in a Morbidly Obese Patient With Acute Limb Ischemia After Failed Femoral-Popliteal PTFE Bypass: A Case Report and Literature Review"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0124-0336","authenticated-orcid":false,"given":"Diego","family":"Sanchez Calderin","sequence":"first","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssam","family":"Farres","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young","family":"Erben","sequence":"additional","affiliation":[{"name":"Mayo 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