Save the Limb- Peripheral Vascular Disease

Save the Limb

People suffering from peripheral vascular disease are often poorly treated and it results in many people losing their limbs. Many times toes and feet are cut off for nonhealing ulcers. Here I am showing the case of a nonhealing ulcer of the right great toe. The case was referred by surgeons and on evaluation was found to have occlusion of all the blood vessels (anterior tibial artery, posterior tibial artery and peroneal artery) supplying blood to the foot. Such cases are technically very challenging to perform. In this case, it was not possible to cross the occlusion from above, so we did a puncture of the Dorsalis pedis artery and did retrograde wiring. Angioplasty of the anterior tibial artery was done and good flow was established.

Figure 1. This a desert foot, where all the three arteries i.e. Anterior Tibial, Posterior tibial and Peroneal, are totally occluded.

Figure 2. Reduced blood supply to the foot resulted in a wound that was not healing for last 4 months.

Figure 3. Puncture of Dorsalis Pedis artery. Since it was not possible to open the occluded vessel from above, puncture of the Dorsalis pedis artery was done.

Figure 4. The occlusion was crossed from below

Figure 5.

Figure 6. Above two images shows restoration of blood flow to the foot after balloon angioplasty of the Anterior tibial artery

Summary: In many cases, we can save a limb from amputation by timely intervention