Critical limb ischemia in patients with diabetes at the organ complication stage represents a considerable challenge in vascular medicine. Because of the complexity of the disease and the often symmetric involvement of both lower limbs, a discrepancy between suitable vascular conduit availability and the actual requirement can occur: notably, the prevalence of multilevel and diffuse arterial disease often limits the possibilities of endovascular treatment, and, in surgical cases, frequently prohibits the effective use of prosthetic material. In our patient with bilateral critical limb ischemia and previous coronary artery bypass graft followed by cardiac transplantation, only one great saphenous vein remained available. That was used in its entirety to salvage one limb as a sequential femorocrural bypass. A similar surgical procedure with a fresh arterial allograft retrieved from a deceased donor was performed on the other extremity . ABO compatibility as well as the chronic immunosuppressive therapy in a heart transplant recipient may have contributed to the favorable long-term clinical outcome of the allogeneic arterial reconstruction.

Department of Vascular Surgery Na Homolce Hospital Prague Czech Republic

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Immunosuppressive protocols with tacrolimus after cryopreserved aortal allotransplantation in rats