Infrapopliteal Bifurcated Dual Run-off Bypass in Critical Limb Ischemia: A Report of 2 Cases

Recently, angiosome-oriented direct revascularization was advocated for infrapopliteal bypass in patients with critical limb ischemia. However, angiosome-matched target vessels, which supply direct blood flow into the ischemic tissue, are frequently small in diameter, severely calcified, have a very poor vascular bed, and might not be suitable technically for distal anastomosis. In such cases, creating a bifurcation in the graft could enable perfusion of a "direct" target vessel with poor quality and an "indirect" run-off vessel with better features. In this report, we present 2 cases of bifurcated dual run-off bypass (BDRB) in which we added a secondary outflow to the original single tibial bypass. Careful investigation and evaluation of the status of the collateral vessels and additional information regarding successful and unsuccessful cases are required to further understand the advantages and disadvantages of BDRB.