Peripheral Arterial Disease
Painful Right Toe
94-year-old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout. The clinical findings of critical limb ischemia – dry scaly skin, nail changes, absent pulses and a punched out ulcer on the 2nd toe – were ignored. Popliteal artery occlusion treated with atherectomy.
Read MoreIschemic Ulceration
92 year old female with left foot rest pain and worsening ulcers of typical of ischemia. CTA demonstrated severe PAD with heavy calcification in the femoral, popliteal, tibial and pedal arteries with a solid wall of calcium at the adductor canal. These types of lesions are often difficult to cross and often result in a…
Read MoreLateral Malleolus Ulcer
86 year old female with a several month history of a painful non-healing ulcer over the lateral malleolus. This area is in the peroneal artery angiosome. Occlusions of the peroneal and posterior tibial artery were treated with orbital atherectomy. Ulcer healed within 1 month.
Read MoreGangrene Failed BPG
83-year-old male, Type I Diabetes, end stage renal disease, living independently who was told he needed a below knee amputation. The patient had a failed popliteal to dorsalis pedis artery bypass graft. An attempt at endovascular repair also failed. The patient came for a second opinion. A second at endovascular repair was successful. The patient…
Read MoreNonhealing Ulcer
82-year-old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture. No pulses in the foot but they could “heard” with doppler. Told to stay off their feet until the ulcer healed. CT angiography shows severe multilevel peripheral artery disease. A simple inflow endovascular procedure restored enough blood flow to achieve healing.
Read MoreRetrograde ATA Recanalization
79-year-old female with non healing ulcers. Occlusion of all three arteries in the calf. Antegrade attempt at opening the anterior tibial artery failed. Retrograde crossing from the distal anterior tibial artery was successful. Treated with orbital atherectomy and angiograplasty. Ulcers healed in under 4 weeks. Entire procedure done in 75 minutes. Patients entire stay was…
Read MoreTwo Failed Fem-Pop BPGs
71-year-old female with a non healing ulcer on the left foot. Previously had a femoral to popliteal artery vein bypass graft which had occluded and was not salvageable. In addition, the patient had end stage renal disease but was not on dialysis. The long superficial femoral artery occlusion was crossed in the subintimal space. Reentry…
Read More2nd 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 More