75 year old male with severe PAD. Prior endovascular AAA repair. Prior right leg bypass graft times 2. Both failed. Prior right leg percutaneous bypass graft 9 months ago for CLI. Worsening left leg claudication and rest pain. Patient has a thrombosed bilobed popliteal artery aneurysms. Recanalization failed using conventional techniques even with antegrade and retrograde access. Sharp recanalization with a Chiba needle was successful in establishing through and through access. Treatment with Viabahn stent grafts and kissing DES into the tibioperoneal trunk and anterior tibial artery. Resolution of rest pain and claudication.
Asymptomatic slowly enlarging internal iliac artery aneurysm
65 year old cyclist with extensive superficial and deep venous incompetence and venous ulceration
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation.