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 subintimal or extra luminal crossing subsequently requiring the use of reentry devices and/or retrograde access to successfully treat. In this case, the occlusion could no be crossed using traditional catheter and wire techniques. A 21g Chiba needle was used to successful cross the lesion and treatment was completed using atherectomy and stenting.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
62 year old female with 2 months of short distance claudication and rest pain at night
82 year old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture.