Endovascular inframalleolar revascularization

The patient is a 70-year-old male with obesity who is a heavy smoker with nonhealing ulcers of the anterior shin and dorsum of the left foot. The initial arteriogram showed patent anterior tibial, posterior tibial, and peroneal arteries (A), occlusion of the inframalleolar posterior tibial artery at the ankle (arrow; B), and reconstitution of the lateral and medial plantar arteries (arrowheads; B). The occlusion was crossed with a 0.014 guidewire, and the lateral plantar artery was entered (C). The occlusion was recanalized using a 2 mm angioplasty balloon that was inflated for 3 minutes (D). The anterior tibial artery was selectively cannulated with the arteriogram showing a distal anterior tibial artery occlusion (E). The lateral tarsal artery occlusion was crossed (F) and treated with a 1.5 mm angioplasty balloon along with the arcuate artery (G) with good result (H). The ulcers were healed by 6 weeks follow-up.