External revascularisation for pseudochronic total occlusion of the dorsal pedis artery due to foot drop with severe diabetes mellitus

Description

A 45-year-old woman with end-stage renal disease and severe diabetes mellitus (haemoglobin A1c (HbA1c) 9.5%) suffered from critical limb ischaemia (CLI). Her right ankle brachial pressure index (ABPI) was 0.77; however, her left ABPI was immeasurable with flat waveform. Additionally, skin perfusion pressure was 34 mm Hg on the left dorsal and 22 mm Hg on the left planter. The angiography showed chronic total occlusion (CTO) of the dorsal pedis artery (DPA) (figure 1, left panel). We electively performed endovascular therapy. The soft wire smoothly passed the CTO of the DPA. We dilated the CTO with a 2.0 mm balloon several times; however, blood flow could not be restored. This discrepancy suggested an unusual CTO. Intravascular ultrasound showed an intact DPA. She also had foot drop due to diabetic neuropathy. Since the entry of CTO was at the dorsal ankle joint, this joint abnormality was considered the cause of the CTO....

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