Dr. Hootman: 44 Year Old Male
Featured Case Overview
44-year-old male, diabetic with hypertension and hyperlipidemia who quit smoking one year prior to suffering a stroke. He initially presented to Modern Vascular in October of 2019 with a gangrenous right 5th toe. Initial angiography confirmed severe multi-segment PAD and he underwent maximal intervention, but, the gangrene progressed requiring a trans-metatarsal amputation and the post-operative wound dehisced early. He returned to Modern Vascular and underwent staged re-intervention in December of 2019 with early wound improvement. Unfortunately, the wound re-opened in April of 2020 at which point he was re-intervened upon with atherectomy of the fem-pop segment and TPT with placement of a drug-eluting stent in the distal SFA. This supplied single vessel run-off via the peroneal artery to an occluded pedal loop which could not be crossed.
Dr. Hootman brought him back for a second intervention and created an intentional deep venous arterialization between the medial plantar artery and vein with outflow via the posterior tibial vein using Rotablator atherectomy and aggressive venous outflow angioplasty. He also received concomitant transcutaneous low-level laser therapy from his podiatrist during follow-up and the wound was nearly closed and dry 3 weeks later.
Progression of would healing
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