Interventions for Pedal Disease

A 71-year-old male, ex-smoker, insulin-dependent diabetic patient presented with right foot rest pain and worsening first and second toes, and heal dry gangrene. The multidisciplinary team decision was to proceed urgently to antegrade angiography from a common femoral artery access, with a view to same-session endovascular treatment. Procedure was scheduled after 2 days and selective infrapopliteal angiogram confirmed the diagnosis of diffuse 3-vessel and pedal arch atherosclerotic steno-occlusive disease, including occlusion of the medial and lateral plantar arteries. The patient underwent angioplasty of the anterior tibial, posterior tibial, and plantar arch reconstruction using the “plantar-loop” technique. The patient reported immediate pain relief. Complete wound healing was noted at 6 months follow-up.