Posts Tagged ‘Chronic Limb Threatening Ischemia’
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 MorePopliteal Aneurysms and Toe Ulcers
The patient was initially seen for ischemic ulceration of right foot toe ulcers and was found to have 2 left popliteal artery aneurysms. The patient declined treatment of the aneurysms at that time. 18 months later the aneurysms occluded and the patient developed ulcerations of several left toes with rest pain. Revascularizion was performed using…
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 MoreDPA Wire Fragment Retrieval
82 year old male with non healing ulcer of the great toe. Severe peripheral arterial disease with long segment occlusion of the posterior tibial artery and severe disease of the distal anterior tibial artery. During crossing of the severe stenosis of the ATA the tip of the hydrophilic wire was bent and then fracture while…
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 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…
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