Critical Limb Ischemia
2nd Toe Ulcer
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation. Although toe amputation sounds simple it leads to biomechanical changes in the foot which can cause progressive deterioration and further more significant amputations. Angiography showed the severe stenosis in the plantar arch. The plantar…
Read MoreFailed Bypass Graft
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…
Read MoreNeuro-Ischemic Ulcer
61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable. No dorsalis pedis artery pulse. Monofilament testing showed decreased sensation typical of diabetic neuropathy. Angiography showed distal PTA stenosis and severe stenosis in the proximal lateral plantar artery – the blood supply to the…
Read MoreBlue Toe from Ulcerated Popliteal Artery Plaque
59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe. Comprehensive workup for an embolic source demonstrated a focal plaque in the popliteal artery. Catheter angiography showed the ulcerated plaque. Directional atherectomy using a SilverHawk atherectomy device was performed. Patients symptoms resolved and at last follow up 2 years…
Read MoreNeuro-Ischemic Ulceration
51 year old male with Type 1 Diabetes and a lateral foot ulcer for 4 months. Patient received standard wound care with slow progression of the ulcer and was offered a below knee amputation. Skin perfusion testing showed normal perfusion. CT angiography demonstrated severe stenosis at the origin of the anterior and posterior tibial arteries…
Read MorePedal Loop Reconstruction
46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle. Angiography shows occlusion of the distal dorsalis pedis artery and of the distal lateral plantar artery. The deep plantar artery and plantar arch were reconstructed and the wounds healed
Read MoreRest Pain in Elderly Female
104 year old female, treated 3 years earlier for critical limb ischemia of the right foot. Now presents with a 2 month history of worsening left foot rest pain.
Read MoreMisdiagnosed Painful Toe
Patient told the pain was due to an ingrown toe nail and sent home on narcotics. The patient went to podiatry and was correctly diagnosed as having critical limb ischemia.
Read MoreThrombosed Popliteal Artery Aneurysm
A 75-year-old male with severe PAD. Prior endovascular AAA repair. Prior right leg bypass graft times 2. Both failed. Prior right leg percutaneous bypass graft 9 months ago for CLI. Worsening left leg claudication and rest pain. The patient has a thrombosed bilobed popliteal artery aneurysms. Recanalization failed using conventional techniques even with antegrade and retrograde…
Read MoreAortoIliac Occlusive Disease
62-year-old male, heavy smoker, with a long history of leg pain with walking. Lumar spine fusion was done with no improvement in symptoms. Exercise ABI’s demonstrated severe peripheral arterial disease. CT angiography showed occlusion of the infrarenal abdominal aorta, bilateral common iliac arteries, left external iliac artery, and severe right external iliac artery disease. Recanalization…
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