Anterior Tibial Artery Angioplasty and Stenting by Retrograde Pedal Artery Approach in Diabetic Patient with Critical Limb Ischemia: A Case Report

Abstract

Endovascular therapy of critical limb ischemia is indicated in high risk patients, especially the diabetics. The ipsilateral antegrade femoral approach is the most common access site. When this approach fails, the retrograde pedal artery percutaneous approach can be considered. A 51-year-old diabetic male patient was presented with severe rest pain and gangrene on his right 4th toe. Computed tomography angiography showed multilevel calcific arterial occlusive disease, involving the popliteal and proximal anterior tibial arteries. Below knee angioplasty and stenting of the right leg was done through ipsilateral antegrade femoral approach and retrograde pedal artery approach. The C-arm guided retrograde pedal approach for calcific artery was useful for recanalization of the occluded anterior tibial artery when antegrade approach failed.