Dr. Broadway featured Case Cover Image

Featured Case
Dr. Broadway: 66 Year Old Female

This week’s Modern Vascular featured case comes from Dr. Dallas Broadway, Vascular Interventional Radiologist for Modern Vascular in San Antonio (Huebner Road), TX.

Featured Case Overview

A 66 yo woman with congestion heart failure, diabetes mellitus, type 2, hypertension, coronary arterial disease and renal insufficiency. She presented with complaints of multiple punctate heal ulcers. She had significant pain causing her to walk on her toes. She had rest pain in the right foot and states she could not bear it anymore. On physical she had monophasic dorsalis pedis, non doplerable posterior tibial and anterior tibial. She had 2+ CFA and non-palpable popliteal arteries. She had a quarter sized ulcer of her left hallux. She had 5 quarter sized to dime sized ulceration of her lateral heal. She had delayed capillary refill. Selective antegrade right lower extremity angiogram using CO2 demonstrated chronic total occlusion involving the P1 and P2 segments of the popliteal artery, segmental anterior tibial artery and full posterior tibial artery. She underwent intervention at that time performing successful recanalization of her P1 and P2 segment popliteal artery with Hawk One atherectomy and balloon angioplasty. The antieror tibial artery was recanalized using angioplasty over an 0.14 wire. An attempt was made to recanalate the posterior tibilal artery proximally resulted in extravasation. The 0.14 wire was then taken through the dorsalis pedis and around the anterior pedal loop into the occluded lateral plantar artery. At this point a fistula was created off the lateral plantar artery into the lateral plantar vein. Prolonged angioplasty was performed.

Progression of wound healing

Wound Healing Progression

Before

Dr, Broadway case study before procedure

Before procedure

After

Dr. Broadway case study after procedure

After procedure

Case Outcome

Post angioplasty fistulogram in the anterior tibial artery demonstrated filling of the deep plantar artery and lateral plantar artery in the posterior tibial vein. Immediately the patient stated her pain had dissipated. On three month follow up the ulcers are nearly completely gone. The fistula remains open. This case demonstrates treatment in chronic limb ischemia has many options and amputation should be the last resort. It’s important to note that patients with stage three renal insufficiency can be performed at the office with the use of Intrasvascular Ultrasound and CO2 angiography limiting the amount of iodinated contrast. As in this case total of 13 cc of contrast was utilized.

Meet the Doctor

Dr. Dallas Broadway Vascular Interventional Radiologist Modern Vascular in San Antonio, TX, Peripheral artery disease specialist

Dr. Dallas Broadway
Vascular Interventional Radiologist

Dr. Broadway is a Diplomate of The American Board of Radiology with Certificate of Added Qualifications in Vascular and Interventional Radiology. He is a specialist in many vascular and interventional radiology procedures.

Learn more about Dr. Dallas Broadway

Dr. Dallas Broadway Modern Vascular Clinic