A Novel Graft Route by Passage under the Achilles Tendon in Paramalleolar Distal Bypass Using the Small Saphenous Vein

A 77-year-old man with diabetes presented to our hospital because of left toe gangrene, requiring infrapopliteal revascularization. The patient was on hemodialysis for renal dysfunction. The great saphenous veins had been used for a previous coronary artery bypass. Hence, the small saphenous vein was applied in a popliteal-to-distal posterior tibial artery bypass. The vein graft was passed under the Achilles tendon to reduce graft length, preventing external compression around the ankle. We performed minor amputation and provided negative pressure wound therapy to promote ulcer healing. The wounds healed entirely after two months.