Case Report Jpn. J. Vasc. Surg., 10:423-427, 2001 
A Case of Autovenous Grafting on the Right Iliac-Left Popliteal Artery
for Repeated Graft Occlusion in Aorto-iliac Occlusive Disease
Yasumitsu Hirano,1 Takeshi Ueyama,1 Yoshinobu Abe,1 Yasushi Matsumoto,2 Masamitsu Endo,1 and Hisao Sasaki2
1 Department of Cardiovascular Surgery, National Kanazawa Hospital
2 Division of Clinical Research, National Kanazawa Hospital

A 56-year-old man was admitted to our hospital because of severe pain in his left leg. His previous history included crossover femoro-femoral bypass, aorto-femoro-popliteal bypass, and thrombectomy because of occlusions of these grafts due to arteriosclerotic occlusive disease.
We carried out emergency thrombectomy but it was not effective. Postoperative angiography revealed occlusions of the left iliac artery and bypass grafts. We peformed extra-anatomic bypass from the right external iliac to the left popliteal artery with an autologous saphenous vein. The Ankle-brachial pressure index improved to 0.78. To the best of our knowledge, there have been no reports of crossover bypass from the external iliac artery to the popliteal artery of the knee joint with a saphenous vein graft. This procedure can be acceptable in patients who have undergone many operations previously or whose occlusive lesion is long.

Key words:
Atherosclerotic occlusive disease, Repeated graft occlusion, Extra-anatomic bypass, Autovenous grafting