No Flow to the Big Toe: Successful Recanalization
An 87-year-old male patient with a previous smoking history presented to his podiatrist for possible bunion treatment at the base of the great toe. It was noted that he had diminished pedal pulses with ABI’s of .6 on the left side. The patient underwent angiography.
The initial angiogram confirmed a total occlusion of the left superficial femoral artery (SFA) as well as minimal infrapopliteal flow (Figure 1). The CTO was approached with a 6 Fr Wildcat device (Avinger) (Figure 2). The CTO was easily recanalized to the infrapopliteal vessels (Figure 3). We then exchanged the Wildcat for a .035 Quick Cross (Spectranetics). After this, we passed a .014 Whisper wire (Abbott Vascular) (Figure 4) into the plantar arch. Balloon inflation occurred with an Amphirion balloon (Medtronic) (Figure 5). Through the Quick Cross catheter, we passed the SpiderFx embolic protection device (Covidien). We then performed balloon inflation at the SFA site with an AngioScore balloon. A Medtronic self-expanding stent was placed at the SFA site with an excellent final result after filter removal (Figure 6).