A 71-year-old man who experienced severe pain after walking just 20 meters was found to have a complete 30-centimeter blockage in his femoral artery alongside silent heart disease. Thanks to a sophisticated vascular bypass operation, surgeons successfully restored blood flow and averted the risk of limb loss.
Severe Intermittent Claudication Halted Daily Life
The patient, identified as Mr. U.N.L. (71 years old), sought medical care at Gia Dinh General Hospital after suffering from persistent numbness and acute leg pain that forced him to stop after walking a mere 20 meters—a textbook sign of severe intermittent claudication.
Clinical evaluations revealed cold extremities and completely undetectable pulses in his popliteal, dorsalis pedis, and posterior tibial arteries. Subsequent Doppler ultrasound and CT angiography (CTA) of the lower extremities uncovered extensive bilateral superficial femoral artery occlusion, with the blockage on the right leg extending over 30 centimeters in length.
Lower limb angiography reveals bilateral superficial femoral artery occlusion.
Hidden Cardiac Risks and a Multidisciplinary Solution
Further diagnostic screening revealed an additional critical finding: coronary CT angiography detected a 60–70% narrowing in the patient’s left anterior descending (LAD) artery, despite the absence of overt cardiac symptoms. The coexistence of severe peripheral arterial disease and silent coronary artery disease posed substantial anesthesia and perioperative cardiovascular risks.
Following an in-depth clinical consultation between Vascular Surgery, Interventional Radiology, and Anesthesiology, the medical team opted for a customized strategy: performing a right femoropopliteal bypass using a reversed autologous great saphenous vein, complemented by real-time intraoperative Digital Subtraction Angiography (DSA).
Vascular surgery and intervention teams collaborate during intraoperative DSA imaging.
Precision Surgery Restores Limb Perfusion
During the operation, surgeons exposed the target vascular regions while the interventional team conducted immediate DSA to examine downstream runoff vessels. The imaging confirmed clear distal patency, eliminating the need for secondary endovascular intervention.
The surgical team then harvested and reversed the patient’s right great saphenous vein, grafting it seamlessly to reroute arterial blood directly from the common femoral artery down to the popliteal artery, effectively bypassing the 30-centimeter occlusion.
Post-operative CTA scan confirms optimal blood flow through the vascular graft.
The intervention was completed smoothly without complications. Postoperative evaluations demonstrated immediate graft patency, with strong, palpable pulses returning to the right dorsalis pedis and posterior tibial arteries. Experiencing marked daily improvement, the patient was safely discharged within four days.
Patient U.N.L. recovering well following successful femoropopliteal bypass surgery.
Why Leg Pain When Walking Should Never Be Dismissed as Aging
Vascular specialists emphasize that chronic lower extremity arterial disease—primarily triggered by atherosclerosis—leads to narrowing or complete blockage of blood vessels feeding the legs. In its initial phases, patients typically experience cramps, tightness, or pain while walking that resolves with rest (intermittent claudication).
If left unmanaged, the condition can escalate into Chronic Limb-Threatening Ischemia (CLTI), characterized by:
- Persistent pain even during rest and sleep.
- Cold, pale, or discolored skin on the feet and toes.
- Non-healing ulcers and progressive tissue necrosis (gangrene).
- Significantly elevated risks of major limb amputation and systemic cardiovascular mortality.
Early clinical evaluation and prompt revascularization remain vital to preserving limb integrity, maintaining mobility, and protecting long-term patient survival.
