This is a case report of a successful popliteal-to-dorsalis pedis artery by pass. The patient had a previous fem oropopliteal bypass which remained patent but failed to halt the ischemic disease. Distal revascularization al lowed a transmetatarsal amputation, which preserved the limb. Bypass to the level of the ankle and foot should always be considered in patients with severe ischemic disease before ampu tation is performed.
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