Case10: Failed Bypass and No Veins - Two Legs Salvaged

Reddened Ischemic Leg with Residual Ulcers

This 66 year old former male smoker was referred February 10th, 1994 by his vascular surgeon. A femoral-to-anterior tibial bypass graft performed three months earlier had failed leaving him with "meager circulation" in his lower leg and foot. Because of the removal of his leg veins for coronary artery bypass procedures in 1981 and 1991 and for his leg bypass in 1993, he had no remaining leg veins for new leg bypasses. He had rest pain in his left foot and could manage walking 50 feet before he experienced pain in both calves. His ankle/arm blood pressure indices were reduced to 0.46 and 0.27 in the right and left legs respectively. PPG tracings were flat in the left toes and barely discernible in the right toes. Residual ulcers remained at the operative sites in his left calf.

Both legs were treated in the Long-Boot in the doctor's office. Within five weeks improvement was obvious (second photograph). Subsequently, his lesions healed and his claudication disappeared. Follow-up, in February 1995, found him walking without difficulty in the shopping malls. He developed new scabs at trauma sites on his left toes in March 1995 and returned for another course of treatments. His feet did well.

Growing Hair, Improved Color and Healing Ulcer

Comments: The leg incisions had not healed three months after his bypass surgery. Having failed bypass surgery, success for a new bypass was diminished if a vein had been available for the procedure. His surgeon had nothing more to offer save leg amputation. Here boot therapy restored both legs to an excellent functional level at a relatively low cost.