Extreme distal bypass to improve wound healing in Buerger's disease

Thromboangiitis obliterans or Buerger's disease is a rare non‐atherosclerotic segmental inflammatory vasculitis that most commonly involves small and medium‐sized arteries, veins and nerves of the extremities, and generally affects young tobacco smokers. A 53‐year‐old man was found to have critical ischaemia of his left lower limb with foot gangrene. He underwent extremely distal surgical revascularisation using a great saphenous vein bypass graft. The choice of a very distal artery as run‐off vessel promoted a faster wound healing and pain relief, with improvement in quality of life.