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.
Percutaneous bypass graft for severe critical limb ischemia
64 year old female with severe short distance claudication limiting the patients ability to work
36 year old with pelvic aching and heaviness, painful intercourse and urinary frequency treated with the "uncoil coil" technique