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.
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation.
86 year old female with a several month history of a painful non-healing ulcer over the lateral malleolus.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.