Successful Cases of Combined Treatment for WIfI Clinical Stage 4 Chronic Limb-Threatening Ischemia Using Popliteal-to-Distal Bypass, Minor Amputation, Debridement, and Rheocarna Therapy in Hemodialysis Patients: A Case Series

(W2I3fI3; stage 4). A right below-knee popliteal-to-dorsal artery in situ bypass was performed, and the necrotic first and fifth toes were amputated, followed by maintenance debridement. Rheocarna therapy was initiated on POD 9 (a nonhemodialysis day following the fourth postoperative dialysis) and administered twice weekly for a total of nine sessions. Three months after surgery, the wound healed. Rheocarna therapy may reduce postoperative fibrinogen, LDL cholesterol and lipoprotein(a), improving microcirculation and avoiding bypass graft failure, surgical site infection and delayed wound healing. Given the limited reports on the use of Rheocarna after distal bypass, it is important to accumulate more cases and long-term outcome data. Further multicenter studies or registry data are needed to validate the optimal timing and frequency of Rheocarna therapy.