Clinical Presentation

A 66-year-old woman who has diabetes presents with a painful, nonhealing ulcer of the right foot.

(A) Lower extremity angiogram shows occlusion of the anterior tibial artery and reconstitution by collaterals (large arrow). The posterior tibial artery is occluded, and a short segment of the peroneal artery (small arrow) is supplied by collaterals and a diseased tibioperoneal trunk (arrowhead). (B) Catheter access across the occlusion in the anterior tibial artery is verified by injection of contrast. (C) SilverHawk (ev3, Plymouth, MN) atherectomy of the anterior tibial artery results in re-establishment of patency (arrow). On more delayed images, the tibioperoneal trunk is patent, supplied predominantly by collaterals.

Differential Diagnosis