The case of the week

June, 13rd - 2014

Double artery reconstruction for double ulcerated foot

The clinical hostory:

89 years old female

Diabetis

Hypertension

Ischemic cardiopathy

Previous endovascular intervention failed 4 months before same leg

Two ulcerated lesions: first metatarsal head and toe, and heel 

 

 001

Fig. 1 - Right foot: first metatarsal head and toe ulcer

 0002

Fig. 2 - Right foot: heel ulcer

Interventional Radiologists’ strategy: perform a diagnostic angiography of right leg and foot to see which arteries are occluded and plane which arteries has to be opened in order to directly feed the two lesions.

Angiographic room: local anestesia of the right groin region. Right common femoral artery puncture and 4 french introducer sheath.

003

Fig. 3 - Antegrade right Common Femoral Artery approach: double critical stenosis of Superficial Femoral Artery (SFA) at the proximal tract

004

Fig. 4 - Superficial Femoral and Popliteal Artery (SFA) aterosclerosis with multiple mild stenosis

005

Fig. 5 - Complete occlusion of Below The Knee (BTK) main arteries  

006

Fig. 6 - Collateral vascularization above the ankle 

007

Fig. 7 - Very weak Dorsalis Pedis and Plantar Arteries 

Endovascular intervention starts with dilation (Percutaneous Transluminal Angioplasty) of SFA stenosis.

008

Fig. 8 -  Balloon inflated inside Superficial Femoral Artery (SFA) on a stenosis

009

Fig. 9 - No flow limiting dissections after SFA Percutaneous Transluminal Angioplasty (PTA) 

After being able to increase the flow until the origin of BTK’s vessels, we catheterize the Anterior Tibial Artery origin and we push the wire inside to re-open it. 

010

Fig. 10 – Recanalization technique: wire loup (just outside a balloon catheter) cuts subintimal space at proximal part of Anterior Tibial Artery

011

Fig. 11 - Recanalization technique: wire loup cuts subintimal space at medial part of Anterior Tibial Artery

012

Fig. 12 - Recanalization technique: wire loup cuts subintimal space at distal part of Anterior Tibial Artery

The wire gains the lumen of Dorsalis Pedis Artey and after we dilate the Anterior Tibial Artery just recanalized we obtain a very good flow direct to the anterior lesions of the foot. Patient feels immediate pain relief.

013

Fig. 13 - Contrast medium injection through balloon catheter shows the lumen of Dorsalis Pedis Artery and distal arteries inside the foot

014

Fig. 14 - Direct blood flow to the dorsal part and toes through Anterior Tibial Artery just recanalized and Dorsalis Pedis

And what about heel ulcer? We must open the direct artery because of a still poor vascularization of that area. Target artery is Posterior Tibial Artery and Plantar Artery

015

Fig. 15 – Below The Knee angiogram trying to find the origin of the total occluded Posterior Tibial Artery

In such a case we use the loup technique to find the right way, to cut the intima and create a new lumen of the diseased/occluded Posterior Tibial, at least until the region of the heel.

016

Fig. 16 - Recanalization technique: wire loup (just outside a balloon catheter) cuts subintimal space at middle part of Posterior Tibial Artery

Our endovascular intervention is totally successful when we obtain a direct blood flow to the foot, and even better, to the lesions

17

Fig. 17 – Final angiogram: Below The Knee arteries regularly patent and direct blood flow to the two ulcerations

After this endovascular intervention good result, we expect the complete heal of the ulcers in three weeks, without partial amputation, and after wound care made by a specialist of our equipe.

 

Le informazioni contenute nel sito non devono sostituire in alcun modo il consulto e la visita medica ma, al contrario, hanno lo scopo di incoraggiare i pazienti a consultare tempestivamente il medico qualora insorgessero problemi.

ATTENZIONE

Il sito contiene immagini fotografiche che potrebbero turbare il visitatore. Chiunque si ritenga particolarmente sensibile non acceda ai sottomenu HOME, ai CASI CLINICI o ad alcuni contenuti multimediali della sezione "VIDEO". A tutela della sensibilità del visitatore i contenuti potenzialmente critici sono sempre evidenziati dal simbolo ().

 

 

email facebook linkedin 

Screenshot 2020 02 06 18.08.27 image.png

 

 

 

 

privacy

Linee guida in tema di trattamento di dati personali per finalità di pubblicazione e diffusione nei siti web esclusivamente dedicati alla salute

Questo servizio utilizza i cookie per offrirti una migliore esperienza di utilizzo. Cliccando su Accetto, acconsenti all'uso dei cookie. Per maggiori informazioni, leggi l'informativa estesa