Case

Dorsalis Pedis and Digital Artery Intervention in Diabetic Foot Ulcer

- Operator : Jong-Young Lee

Dorsalis Pedis and Digital Artery Intervention in Diabetic Foot Ulcer
- Operator: Jong-Young Lee, MD
Clinical Information
The patient was 56-year old gentleman with diabetes. He admitted for the wound at right 3rd and 4th toes which showed gangrenous changes with ulceration. The ABI (ankle-brachial index) was normal, but lower extremity CT angiography showed total occlusion of right ATA and PTA.
Baseline Peripheral Angiography
Right SFA and popliteal artery was patent but ATA and PTA were totally occluded. The circulation of foot was only dependent on the peroneal artery and the collateral flow. In addition, blood flow didnt reach the wound site ( Movie 1, Movie 2, Movie 3).
Procedure
A 6F sheath was inserted into right femoral artery by antergrade approach. After angiograpy, 4F shuttle was inserted via sheath for the below the knee intervention. We passed the CTO lesion of ATA using 0.014 Fielder XT wire with over-the-wire balloon. After confirming the true lumen via over-the-wire balloon( Movie 4), 0.018 V-18 control wire was inserted and balloon angioplasty for dorsalis pedis artery and the ATA was performed with Fox 2.0 x 40mm, SLEEK 2.0 x 220mm, SLEEK 2.5 x 220mm by stage (Figure 1). After balloon angioplasty, ATA and dorsalis pedis flow was getting better, but far distal blood flow to the wound site was not sufficient. So we tried wiring to the digital artery with Fielder XT wire and performed balloon angioplasty with coronary 1.5 x 15mm balloon (Figure 2). Final angiogram showed a successful result and good blood supply to the right foot ( Movie 5, Movie 6, Movie 7).

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