Chronic limb-threatening ischemia, successful infra popliteal endovascular revascularization: a case report

Abstract

Introduction: Chronic limb-threatening ischemia (CLTI), a manifestation of peripheral arterial disease (PAD) that is characterized by chronic ischemic pain in the foot, inadequate tissue perfusion at rest more than 2 weeks, non-healing wounds, or gangrene that is attributable to objectively proven arterial occlusive disease. Endovascular surgery has played an important rules for revascularization in limb saving.Case description: 57-years-old man came to the Zainoel Abidin General Hospital emergency room, with a chief complaint of ischemic pain at the right foot since 3 months ago, and being extremely progressive for 10 days. He has no history of smoking and 10-year history of controlled type 2 diabetes mellitus. On the physical examination revealed a stable hemodynamic, an unhealed wound in the right lower limb as well as an open wound size 10cm x 6cm x 4cm. He has palpable femoral pulses but not distal pulses. Peripheral CT angiography obtained a total occlusion at the right anterior tibialis artery (ATA), and no flows at the right dorsalis pedis artery (DPA). Performed a revascularization procedure with endovascular therapy using 3 mm balloon angioplasty with good results along the ATA and DPA. The patient was discharged on the 4th day after surgery. Clinical Evaluation after 2 months showed improvement on pain, good ulcer healing and ready for skin grafting.Conclusion: The goal of treatment for CLTI is to relieve pain, heal wounds, and preserve a functional limb, with a cornerstone of treatment is timely arterial revascularization Endovascular surgery in one of the best revascularization techniques for CLTI.