Exploring Limb Salvage Options In Patients With Chronic Limb Ischemia

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Here one can see hemodynamically significant stenosis at the origin of the left anterior tibial artery.
This control angiogram was taken following CryoPlasty therapy with a 3.0 mm balloon.
As one can see here, the stenosis of the left dorsalis pedis artery crosses the ankle joint.
Surgeons used a 2.5 mm diameter CryoBalloon across the dorsalis pedis artery stenosis.
Here is a control angiogram of the dorsalis pedis artery following 2.5 mm CryoPlasty therapy. As one can see, there is significant improvement in the caliber of the artery with a focal area of vasospasm several millimeters below the ankle joint.
After the patient underwent transmetatarsal amputation, the left foot showed exuberant bleeding. This signifies good blood flow to the wound site.
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Author(s): 
By John E. Aruny, MD, Peter Blume, DPM, Bauer Sumpio, MD, PhD, and Benjamin Buren, DPM

   This case study demonstrates the suitability of delivering the small vessel cryoballoon to a distal lesion below the ankle. The patient underwent angioplasty without the creation of a prominent dissection across a 30 mm length occluded segment and two additional sites. There was vigorous bleeding during surgery, a favorable prognostic sign, and the surgical wound was healing at three weeks.

   While the primary objective in this case is limb salvage and wound healing, further follow up in a controlled environment will be necessary before one can make statements regarding patency rates.

Dr. Aruny is an Assistant Professor and Co-Chief of Vascular and Interventional Radiology at Yale University School of Medicine. Dr. Aruny can be contacted at john.aruny@yale.edu.

Dr. Blume is a Clinical Assistant Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine. He is also a Fellow of the American College of Foot and Ankle Surgeons, and is the Director of Limb Preservation at the Yale New Haven Hospital in New Haven, Conn.

Dr. Sumpio is the Chief of the Section of Vascular Surgery at the Yale University School of Medicine.

Dr. Buren is a Chief Resident in the Section of Podiatric Surgery within the Department of Orthopedic Surgery at the Yale University School of Medicine.

Editor’s Note: This article was adapted with permission from the December 2004 issue of Vascular Disease Management.




References:

1. Spinosa DJ, Leung DA, Matsumoto AH, et. al. Percutaneous intentional extraluminal recanalization in patients with chronic critical limb ischemia. Radiology 2004; 232:499-507.
2. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: Description of a new technique and a preliminary report of its application. Circulation 1964;30:654-670.
3. Schwarten DE. Clinical and anatomical considerations for nonoperative therapy in tibial disease and the results of angioplasty. Circulation 1991;83(2 suppl):I86-I90.
4. Bolia A, Brennan J, Bell PR. Recanalisation of femoro-popliteal occlusion: improving success rate by subintimal recanalisation. Clin Radiol 1980;40:325.
5. Lipsitz EC, Ohki T, Veith FJ, et. al. Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? J Vasc Surg 2003;37:386-91.



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