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Case of lower limb revascularisation using composite sequential bypass graft with a ‘diamond’ intermediate anastomosis
  1. Cherry Cheung1,
  2. Ailin Rogers1,
  3. Morgan Peter McMonagle1,2
  1. 1 Surgery, University Hospital Waterford, Waterford, Ireland
  2. 2 Trauma, St Mary’s Hospital, London, UK
  1. Correspondence to Morgan Peter McMonagle, drmorganmc{at}


In patients with critical infracrural disease, autologous saphenous vein grafting offers the best reported conduit patency and limb salvage rates but is only feasible in approximately 30% of patients due to the lack of available or suitable vein. In the absence of a suitable length of available vein, various composite grafting techniques have been explored with the aim to improve graft longevity, maximise native vein use and improve overall clinical outcomes, including limb salvage rates. We report a case of a 66-year-old man with critical limb ischaemia and a history of venous disease, where a complex composite sequential bypass graft combining both native vein and synthetic graft, incorporated into a novel intermediate anastomotic technique in a ‘diamond’ configuration, offered promising results in limb salvage. This case highlights the key steps and advantages in this novel technique.

  • vascular surgery
  • general surgery

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  • Contributors The first author (CC) had main contributions to the conception and design of the work, as well as drafting and revising it. AR and MPM contributed to providing images, guidance on discussion, as well as review and revisions of the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.