68-year-old female presented with chronic non-healing lower extremity wounds. She has a medical history significant for insulin dependent type 2 diabetes mellitus, hypertension, hyperlipidemia, morbid obesity (BMI 31.5), and chronic renal failure. The patient was referred for evaluation of a chronic shallow ulcer about the right lateral ankle measuring 4 x 3.5 x 0.5 cm succumbing to repeated infections and failed healing for more than 1 year despite diligent wound care and debridement. Initially diagnosed and treated as a venous stasis ulcer but due to the persistent non-healing an arterial component was suspected. Distal pulses were non-palpable and monophasic on Doppler. Interestingly, this ulcer had a mixed venous and arterial component.

Initial Wound & Diagnostic Angiogram

Final Angiogram
60% stenosis of distal ATA / 90-99% stenosis of DPA & loop

Intervention: Rotablator atherectomy & balloon angioplasty

Rotoblator atherectom and balloon angioplasty
Angiogram of foot

Final Angiogram

Featured Case Modern Vascular in Tucson, Dr. Jack Hannallah

Clinical follow-up 1 month / 2 months

Clinical follow up 1month / 2months