Presentation
Chronic non-healing ulcer over the metatarsophalangeal joint of the left foot.
Patient Data
Diagnostic angiography (first stack).
SFA angioplasty (second stack): A 5 x 40 mm Admiral xTreme (Medtronic) balloon was used over a number of regions in the SFA, primarily to treat the high grade focal stenosis in the proximal third of the artery.
Post SFA angioplasty (third stack).
PTA angioplasty (fourth stack): A 2 x 120 mm (Medtronic) balloon was introduced over a 0.014 wire down to the ankle. Initial angioplasty demonstrated improvement proximally. Repeat angioplasty slightly more distally was thus performed.
Post PTA angioplasty (fifth stack): Excellent post procedure result with the posterior tibial having a normal caliber.
Case Discussion
A down hill puncture was performed and diagnostic angiography obtained, demonstrating:
- moderate to high grade focal stenosis in the SFA with a more general region of narrowing distal to it.
- occluded anterior tibial distal to its origin
- trickle flow only though tight long segment stenosis of the posterior tibial artery, from mid calf to ankle joint.
5000 units of heparin were administered and angioplasty of the SFA performed over a 0.035 wire using a 5 x 40 mm Admiral xTreme (Medtronic) angioplasty balloon.
The wire was exchanged for a 0.014 floppy tip wire, which was passed through the PTA stenosis down to the ankle joint. A 2 x 120 mm angioplasty balloon was then used to angioplasty approximately 20 cm of vessel with excellent angiographic result.
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