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.