Dr Rundback Pedal Arch Reconstruction Case

Dr. John H. Rundback specializes in complex endovascular interventions—treating the most challenging cases of Critical Limb Ischemia and Peripheral Artery Disease.

Patient History and Consultation

• A 92-year-old woman with painful digital ulceration and focal gangrene left foot DESPITE RECENT OUTSIDE FEMOROPOPLITEAL ANGIOPLASTY.
• Cardiovascular risk factors are age, HTN, dyslipidemia.  She does not have a history of DM, CAD, renal dysfunction, or smoking.
  

Patient Plan and Treatment

• Tibial and pedal revascularization to restore straight-line flow and perfusion to painful ischemic and early gangrenous digits.
• Extensive tibial occlusive disease with severe calcific stenosis of the posterior tibial artery was successfully treated with laser atherectomy and angioplasty with restored unobstructed flow through the medial plantar runoff. The posterior tibial artery and the lateral plantar runoff are occluded. Severe disease of the dorsal pedal artery and occlusion of plantar pedal arch successfully treated with angioplasty with remarkable results and restored plantar pedal arch patency and uninterrupted straight-line flow to the patient’s affected areas of focal gangrene in the second and fourth digit.

Angiogram

Patient Follow-Up

Discussion

• Foot and toe wounds require dedicated revascularization of the more challenging tibial arteries below the knee and the arteries of the foot (pedal loop arteries).
• Disease in these arteries is characterized by long complete blockages and dense hardening of the arteries due to calcium deposits that require specialized experience, skills, and tools for successful treatment.
• Opening up the “inflow” arteries of the upper leg often is insufficient!  This patient had ongoing pain and early gangrene despite recent “inflow” angioplasty.
• CRITICAL LIMB-THREATENING ISCHEMIA CAN BE SUCCESSFULLY TREATED OVER 80% OF THE TIME EVEN WHEN OTHER DOCTORS HAVE FAILED OR NOT HAD THE NECESSARY EXPERIENCE FOR OPTIMAL RESULTS.