Examination of the cold foot revealed anemia and near-necrosis.

The patient experienced intermittent pain while walking and cold feet. Doctors discovered that most of the blood vessels in the lower limbs were blocked, causing severe ischemia and posing a risk of necrosis.

During an examination at Tam Anh General Hospital in Ho Chi Minh City, Mr. Ngo Phong (77 years old, residing in Cu Chi, Ho Chi Minh City) was found to have an ABI (the ratio of ankle arterial pressure to brachial arterial pressure) of 0.6 in his right leg and 0.5 in his left leg. This is a 50% decrease compared to a normal person (ABI equals 1), indicating severe ischemia in both legs. Ultrasound and CT scans to determine the cause of ischemia revealed that the superficial femoral artery (the artery near the skin surface that supplies blood to the leg) was almost completely blocked for a length of 10-15 cm in both legs.

Mr. Phong has a history of diabetes, hypertension, and dyslipidemia. One month before hospitalization, he experienced intermittent pain when walking about 10 meters, coldness in his lower legs and feet, fatigue, and poor appetite.

When arteries in the body narrow or become blocked, reducing blood flow to the feet, the resulting ischemia leads to cold feet. "If blood flow is not restored promptly, the feet will not receive adequate blood supply for an extended period, causing tissue death (necrosis), and the patient risks amputation," said Dr. Nguyen Anh Dung, Head of the Cardiovascular and Thoracic Surgery Department, Cardiovascular Center.

According to Dr. Dung, there are two common methods for treating lower extremity arterial occlusion: angioplasty with stent placement and bypass surgery. However, the patient was elderly, and the blood vessels were so severely hardened by atherosclerosis that it was impossible to insert a catheter for stent placement. Therefore, the surgeon performed a femoral-popliteal artery bypass graft to restore blood flow to Mr. Phong's leg.

Dr. Nguyen Anh Dung and his team of cardiovascular and thoracic surgeons performed a femoral artery bypass graft surgery on a patient. Photo: Tam Anh Hospital

First, the surgeon ruptures the saphenous vein valve (a vein with one-way valves that carry blood from the foot back to the heart). Then, the surgeon creates a bypass graft, connecting the upper end of the saphenous vein to the superior femoral artery and the lower end to the popliteal artery (after the blockage of the femoral artery) to direct blood flow from the thigh down to the foot (instead of the other way around). This is a modern method preferred in femoral artery bypass surgery. The surgeon does not need to take blood vessels from elsewhere but uses the saphenous vein itself as a bypass graft. The advantage of this technique is that it simplifies the surgical process and reduces the risk of post-operative vascular stenosis.

To perform this technique, the operating room needs to be equipped with valve-breaking instruments and modern machinery. At the same time, the surgeon must perform the valve-breaking procedure precisely, avoiding valve insufficiency which can lead to leg swelling and difficult-to-heal leg ulcers.

After the surgery, Mr. Phong was able to take gentle steps. The incision healed quickly, blood circulation in his leg improved, and his leg became warm and rosy. He also underwent physical therapy to speed up his recovery.

According to Dr. Dung, the main causes of lower extremity arterial occlusion stem from cardiovascular diseases such as dyslipidemia, myocardial infarction, valvular heart disease, and arterial aneurysms. To prevent this, individuals should limit foods high in unhealthy fats; exercise regularly, avoid being overweight or obese; refrain from smoking and excessive alcohol consumption; and manage and control blood lipid levels. Patients with atherosclerosis, diabetes, and hypertension should regularly check their feet, and any wounds, ulcers, blisters, or discoloration should be examined immediately.

Thu Ha

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