Featured Case Overview
An 87 year old Hispanic American male was referred with a non-healing left great toe ulcer for over one month. He was initially told by his PCP that given his age his wound would be managed expectantly. He was seen by his podiatrist who referred him to Modern Vascular knowing our abilities to successfully treat patients with minimally invasive techniques. This was despite his customary practice of sending patients to the large peripheral vascular group in town.
During the patient’s consultation visit, he admitted to having some claudication symptoms as well but no rest pain. He did have neuropathy. On physical exam he had a palpable femoral pulse but his pedal pulses were non palpable. He had an ulcer on the tip of his great toe. His US showed biphasic waveforms in the superficial femoral and popliteal arteries and severe occlusive tibial disease.
Images Pre Intervention
Images Post Intervention
The patient was treated in a staged fashion. His initial procedure was remarkable for significant SFA and popliteal artery disease. His occlusive tibial disease could not be crossed. The patient’s SFA and popliteal disease were treated with atherectomy and angioplasty with a good result. He was brought back for the staged treatment and both antegrade SFA and retrograde posterior tibial access was performed. His retrograde access was reversed and his posterior tibial sheath was removed. He was then treated in an antegrade fashion successfully through the pedal loop. He returned 2 weeks later with a near completely healed toe wound.
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