The surgeons in Sarandí who refused to take the leg

At Hospital Presidente Perón in Avellaneda, south of Buenos Aires, a man arrived with a right leg that was slowly dying and no options left. Two doctors, Alejandro Trainini and Martín Rodrigo, built him a new circulatory route through his own veins. He walked out 48 hours later.

Trainini, who heads cardiovascular surgery at the provincial hospital in Sarandí, and Rodrigo, from the hemodynamics service, decided to attempt something else: a single operation combining open surgery with catheter work, staged so that each part fed the next.

They began at the aorta, rebuilding the bifurcation with covered stents — a technique known as CERAB, first described in the Netherlands — to restore pressure into the leg. Then came the unusual part. Since the arteries below could no longer carry blood, the team routed it into the veins instead, running a biosynthetic conduit from the external iliac artery to the popliteal vein and finishing with a stent placed in the posterior tibial vein to push arterial blood down through the venous system to the foot.

The idea of sending arterial blood backwards into a limb's veins is old — a French physiologist proposed it in 1881, and Halsted attempted it in 1912 — but it failed so consistently for most of the twentieth century that surgeons abandoned it. It returned only in the last decade, in purely catheter-based form.

To the team's knowledge, this combination had never been performed anywhere in the world.

Circulation in the foot returned. There were no complications, and the patient was discharged two days after the operation.

The conduit sewn into his leg has an origin stranger than the operation. The Omniflow graft is not a plastic tube: a polyester mesh is implanted under the skin of a sheep, which spends roughly twelve weeks wrapping it in collagen before the composite is harvested and chemically stabilised. It is sold in Europe, Australia and parts of Latin America, and has never been cleared in the United States — one reason this particular combination would be hard to repeat in an American centre.

Hospital Presidente Perón sits just south of the Riachuelo, the river dividing Buenos Aires from its industrial suburbs. It is run by the province, not the nation, and it treats its patients without charge. The man who came to it expecting to lose his leg left still standing on it.