Drug-eluting stent patency at 6 months in the pedal artery of a patient with polyarteritis nodosa: a case report

Successful bilateral popliteal-plantar bypasses for polyarteritis nodosa induced ischemia

Polyarteritis nodosa (PAN) is a rare vasculitis that can cause peripheral ischemia. We present the case of a 49-year-old man who developed PAN causing toe gangrene and severe rest pain in one foot and claudication of the contralateral foot. He was treated with immunosuppression and underwent popliteal-plantar artery bypass with resolution of rest pain and subsequent amputation of his mummified toe. Despite remission of PAN, his contralateral foot claudication was lifestyle limiting; thus, 5 years later he underwent contralateral popliteal-plantar bypass with resolution of claudication. This case demonstrates the anatomically symmetric presentation of PAN induced ischemia with successful open revascularization after resolution of inflammatory markers with systemic therapy.

Stent-Apposition Salvage of an Anterior Tibial Artery After Inadvertent Angioplasty Balloon Retention During CTO Revascularization

Introduction

Progressive improvement in the ability to treat complete total occlusions in the tibial level arterial circulation have made it possible to revascularize patients with critical limb ischemia.

Report

A 59 year old male presented with a complete total occlusion of his anterior tibial artery with distal reconstitution through peroneal artery collaterals. During attempted angioplasty a balloon was retained within the patent portion of the target vessel. Two 3.0 mm drug eluting coronary stents were deployed across the length of the balloon with excellent luminal preservation.

Discussion

Successful CTO revascularization was completed and a strong dorsalis pedis artery pulse was restored following intervention.

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Improved treatment for tibial level arterial occlusions makes revascularization possible.

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A balloon was retained in the target vessel and two coronary stents were deployed across the balloon.

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CTO revascularization was successful with restoration of a strong dorsalis pedis pulse.