51 year old male with Type 1 Diabetes and a lateral foot ulcer for 4 months. Patient received standard wound care with slow progression of the ulcer and was offered a below knee amputation. Skin perfusion testing showed normal perfusion. CT angiography demonstrated severe stenosis at the origin of the anterior and posterior tibial arteries with variant pedal artery anatomy. Catheter angiography underestimated the degree of stenosis. Intravascular US was performed which clearly showed the degree of luminal loss. Stenting with drug eluding stents was performed. Ulcer healing was achieved 3 months after revascularization.
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
Sharp recanailziation of a heavily calcified SFA occlusion
59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe.