This week’s Modern Vascular featured case comes from Dr. Albert Chun, Board-Certified Vascular & Interventional Radiologist for Modern Vascular in Fairfax, VA.

Featured Case Overview

65-year-old male with DM, HTN, CAD, and prior toe amputations presented with worsening R plantar ulcer over 3 months (image A). On exam, the right foot was cool to touch with monophasic doppler DP signal. The PT was absent. Arterial doppler showed patent femoropopliteal segment, elevated PSV in the AT, and densely calcified occlusion of the PT.

Right lower extremity angiogram was performed which confirmed chronic total occlusion of the distal PT as well as the lateral plantar artery (image B). Antegrade recanalization of the PT was successful, but the lateral plantar artery (angiosome of concern) could not be recanalized. The wire was parked in the medial plantar artery and a second wire was advanced retrograde through the occluded lateral plantar artery via the DP and arcuate artery (image C). The second wire was then captured with a snare at the femoral sheath.

Intraluminal position was confirmed with intravascular ultrasound. Atherectomy (Rotablator 1.75) with angioplasty  was performed in the distal PT (image D). Prolonged angioplasty was performed in the lateral plantar artery and pedal arch (image E). Final angiogram showed in-line antegrade flow through the PT, lateral plantar, and arcuate arteries (images F,G).

The patient returned to clinic for 2 week post-operative visit and had doppler PT and DP signal in the right foot with interval progression of wound healing. At three month follow up the patient had near complete wound healing (image H) and had resumed walking.

Before

Plantar Before Picture Dr. Chun 65 Year Old Male

A: Plantar Pre-Intervention

Pedal Baseline Dr. Chun 65 Year Old Male

B: Pedal Baseline

Intervention

Intervention Angiogram Dr. Chun 65 Year Old Male

C: Intervention Angiogram

Intervention Angiogram Dr. Chun 65 Year Old Male Modern Vascular

D: Intervention Angiogram

Dr. Chun 65 Year Old Male Intervention Angiogram

E: Intervention Angiogram

After

Post Intervention Dr. Chun 65 Year Old Male

F: Post-Intervention Angiogram

G Post- Intervention Dr. Chun Featured Case

G: Post-Intervention

Plantar After Picture Dr Chun 65 Year Old Male

H: Plantar Post-Intervention

Meet the Doctor

Dr. Albert Chun Vascular Interventional Radiologist at Modern Vascular in Fairfax, VA, peripheral artery disease specialist

Dr. Albert Chun
Board-Certified Vascular & Interventional Radiologist

Board Certified in Vascular and Interventional Radiology for over 15 years. Former Instructor of Radiology at Harvard University and Assistant Professor of Radiology and Surgery at George Washington University.

Learn more about Dr. Albert Chun

Dr. Albert Chun Modern Vascular Clinic

Modern Vascular of Fairfax

2812 Old Lee Highway #100 B-D
Fairfax, VA 22031

Office Hours: 7am-6pm EST

Phone: (571) 279-6849

Fax: (571) 281-8697

Email: [email protected]