Recanalization of tibial arteries

The patient is an older male with diabetes, coronary artery disease, and chronic obstructive pulmonary disease. He presented with chronic ischemic ulceration of his left great toe and heel. The arteriogram demonstrates severe tibial vessel disease with proximal anterior tibial and posterior tibial stenoses (arrows; A) and a proximal peroneal artery occlusion. Each of the lesions were crossed simultaneously using three buddy wires (B), and subsequently each was balloon angioplastied (C). Completion arteriography demonstrated inline revascularization of each vessel to the foot (D).