PMC5576009_01
Complete total occlusion right anterior tibial artery.
gr1.jpg
PMC5576009_01_gr1.jpg
fig1
The ATA was patent but diseased in its proximal one-third, followed by a CTO in its mid-portion, and reconstitution distally through peroneal artery collaterals (Fig. 1).
Angiogram of the right lower extremity with run off.
gr2.jpg
PMC5576009_01_gr2.jpg
fig2
The tibio-peroneal, peroneal, and posterior tibial arteries were all patent; however, none of these vessels were in the angiosome distribution of the wound (Fig. 2).
Retained angioplasty balloon (white arrows) and attempted retrieval angioplasty balloon (red arrows).
gr3.jpg
PMC5576009_01_gr3.jpg
fig3
Attempts at retrieval included use of a coronary snare (Amplatz Goose Neck, 2 mm x 200 cm x 175 cm, 2.3-3.0 Fr) and a "buddy" balloon (2.5 x 150 mm, Sterling, Boston Scientific) insufflated adjacent to retained balloon (Fig. 3).
Proximal and distal markers, retained angioplasty balloon.
gr4.jpg
PMC5576009_01_gr4.jpg
fig4
ATA just above the ankle. A 0.014 in wire was placed in the dorsalis pedis artery and a 3.0 x 20 mm and an overlapping 3.0 x 24 mm series of everolimus drug eluting stents (Promus, Boston Scientific) were deployed across the retained balloon and angioplastied (2.5 x 40 mm, Coyote, Boston Scientific) (Figure 4, Figure 5).
In line flow through stent opposed retained angioplasty balloon.
gr5.jpg
PMC5576009_01_gr5.jpg
fig5
ATA just above the ankle. A 0.014 in wire was placed in the dorsalis pedis artery and a 3.0 x 20 mm and an overlapping 3.0 x 24 mm series of everolimus drug eluting stents (Promus, Boston Scientific) were deployed across the retained balloon and angioplastied (2.5 x 40 mm, Coyote, Boston Scientific) (Figure 4, Figure 5).