92 year old female with left foot rest pain and worsening ulcers of typical of ischemia. CTA demonstrated severe PAD with heavy calcification in the femoral, popliteal, tibial and pedal arteries with a solid wall of calcium at the adductor canal. These types of lesions are often difficult to cross and often result in a subintimal or extra luminal crossing subsequently requiring the use of reentry devices and/or retrograde access to successfully treat. In this case, the occlusion could no be crossed using traditional catheter and wire techniques. A 21g Chiba needle was used to successful cross the lesion and treatment was completed using atherectomy and stenting.
Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia
101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot.