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This week’s Modern Vascular featured case comes from Dr. Anthony C. Pozun, DO, Board-Certified Interventional Cardiologist for Modern Vascular in Glendale, AZ.

Overview

This is an 89-year-old gentleman with a history of hypertension, diabetes, and dyslipidemia who underwent amputation of the right second toe due to gangrene and infection in March 2022. This patient had not undergone any noninvasive imaging of the right lower extremity vasculature prior to amputation. Approximately 2 weeks after amputation, the incision site became gangrenous with multiple nonhealing ulcerations. He was seen by a vascular surgeon in the greater Phoenix area who did not offer him any surgical or endovascular options due to his age and multiple comorbidities.

 

This patient was then referred to Modern Vascular in Glendale for consultation and based on obvious clinical findings of grossly abnormal arterial Dopplers and ABIs, he was scheduled for a right lower extremity angiogram with potential intervention.  Right lower extremity angiography was performed via proximal superficial femoral artery antegrade access with a 7 French sheath. As seen in the provided images, the right popliteal artery was occluded throughout its entirety, along with the right tibial peroneal trunk. There is the reconstitution of the right peroneal and right posterior tibial arteries via multiple geniculate collaterals. Using a 90 cm 0.035-inch Navicross catheter, I was able to pass through the extensive chronic total occlusion using both 0.35in Bentson and 0.14in Command wires. Intravascular ultrasound confirmed intraluminal position throughout the entire course of the occlusion.

 

The pedal plantar loop was also heavily diseased and imaged. The plantar portion of the loop was 100% occluded. Jetstream atherectomy was performed of the right popliteal and tibial peroneal trunk extending into the posterior tibial artery. This was followed by percutaneous transdermal angioplasty of the right popliteal, right tibial peroneal trunk, and right PT arteries. Angioplasty of the pedal plantar loop was also performed. Pre-and post-intervention images are provided with this narrative. The patient was discharged in stable condition from the clinic on 3 months of anticoagulation including clopidogrel 75 mg daily and Xarelto 2.5 mg twice a day. Patient will continue with aggressive management of diabetes in maintaining the Hba1c < 7%. He will remain on statin therapy in order to maintain an LDL less than 70. Patient was seen 2 weeks postop and the wounds are healing with adequate perfusion distally.

 

Before & After Angiogram Images

Dr. Pozun 89 yo patient - pre
Pre - Dr. Pozun 89 yo patient
Post - Dr. Pozun 89 yo patient
Dr. Pozun 89 yo patient - post

Meet the Doctor

Interventional Cardiologist Anthony Pozin

Dr. Anthony C. Pozun, DO
Board-Certified Interventional Cardiologist

Dr. Anthony C Pozun, DO, FACC has been providing comprehensive and compassionate care to his patients in the greater Phoenix area for over 15 years. He is board-certified in both Cardiovascular Disease and Interventional Cardiology.

Learn more about Dr. Anthony C. Pozun, DO

Clinic Details

Modern Vascular in Glendale

11851 N 51st Ave. F140
Glendale, AZ 85304
(602) 362-3035

Office Hours: 7am-5pm MST

Fax: (602) 362-3036

Email: [email protected]

Modern Vascular in Surprise

14733 West Mountain View Boulevard Bldg F.
Surprise, AZ 85374
(602) 892-0917

Office Hours: 7am-5pm MST

Fax: (602) 842-7106

Email: [email protected]