Successful limb salvage from critical limb ischemia with bilateral variant anatomy of infrapopliteal arteries

Excerpt

An 88-year-old man was admitted to our hospital for the treatment of refractory ulcers on both heels. Computed tomography angiography showed severe bilateral stenosis of the anterior tibial artery (ATA) and occlusion of the tibio-peroneal trunk. We initially performed endovascular treatment (EVT) for the left lower limb. The left plantar artery was perfused via the collateral artery from the ATA (Fig. 1a, b). Therefore, we performed trans-collateral angioplasty (TCA) from the ATA (Fig. 1c), and successfully recanalized the occluded vessel. The plantar artery communicated from the peroneal artery, considered as the type III-A variant anatomy of infrapopliteal arteries (Fig. 1d). In the next session, initial angiography of the right infrapopliteal arteries was considered to be similar with that on the left (Fig. 1e, f). Then, we performed TCA from the ATA in the same way as the procedure on the left side (Fig. 1g), and successfully recanalized the occlusion. The right side also displayed the type III-A variant anatomy (Fig. 1h). Refractory ulcers on both sides favorably healed after revascularization (Fig. 1i, j).

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