62 year old male, heavy smoker, with a long history of leg pain with exertion. Under went spinal fusion with no improvement in symptoms. Exercise ABI's demonstrated severe peripheral arterial disease. CT angiography showed occlusion of the infra renal abdominal aorta, bilateral common iliac arteries, left external iliac artery and severe disease of the right external iliac artery. Recanalization was difficult and ultimately accomplished using a sharp reentry technqiue with a Chiba needle into the abdominal aorta. Covered endografts were used to treat the patient. ABI's were normalized post procedure.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
64 year old female with severe short distance claudication limiting the patients ability to work
The tip of a hydrophilic wire was fractured and subsequently retrieved during the crossing of a distal anterior tibial artery near occlusion