Internal Iliac Artery Revascularization to Save an Above-the-Knee Stump: Case Report

Purpose: Poor stump healing concerns a significant number of patients. It can be due to lack of vascularization or infection. We report the case of an above-the-knee (ATK) stump wound treated by atypical revascularization.

Materials and Methods: A 46-year-old man had a large ATK stump wound. He had a history of bilateral deep vein thrombosis; pulmonary embolism; stroke; renal infarction; left femoral artery endarterectomy with stenting of the left common iliac artery; embolectomy of the left iliac, femoral, and popliteal arteries; and a prosthetic femoro-femoral bypass from the right to the left. He had toe necrosis due to thrombosis of the superficial femoral and popliteal arteries. He had undergone several attempts at revascularization. At least he had an amputation ATK. The following evolution was not favorable, with large stump wound development. The common iliac, external iliac, and common femoral arteries were occluded. The ipsilateral internal iliac artery was still patent.

Results: We performed a percutaneous common iliac artery recanalization by left humeral puncture to enhance the inflow into the left lower limb through the internal iliac artery. The external iliac and common femoral occlusions were not treated because of the heavy previous history. After 1 month, the stump was completely healed.

Conclusions: Percutaneous recanalization of the common iliac artery to increase the inflow into the left lower limb through the internal iliac artery is helpful to ensure healing of a wound stump.