Treatment of posterior tibial artery lesion

The patient was an 86-year-old with diabetes and right heel gangrene. The arteriogram shows an occlusion of the right posterior tibial artery just distal to the trifurcation (arrow; A). The anterior tibial artery also occludes (arrowhead; A). The posterior tibial artery reconstituted distally in the midcalf (B). Using distal posterior tibial access, the posterior tibial lesion was crossed with a wire (arrow; C) and angioplastied. The posterior tibial artery before (thick arrow; D) and after angioplasty (dashed arrow; E) are shown. With direct revascularization to the heel via the posterior tibial artery, the wound healed.