64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft. The later graft failed and the patient was told there were no other options to restore blood flow. Endovascular reconstruction of the popliteal artery and tibioperoneal trunk restored blood flow and wound healing was achieved.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.