Transpedal Approach for the Treatment of Acute Limb Ischemia in a Patient with Limited Access Sites

Abstract

We present a 53-year-old male with a history of extensive peripheral vascular disease, including a repaired type B aortic dissection complicated by occlusion of the left subclavian artery requiring carotid to subclavian bypass. The patient then had a subsequent repair of a graft endoleak complicated by left iliac artery occlusion requiring fem-fem bypass. He presented to the ED with left foot pain concerning for acute limb ischemia needing for prompt revascularization. However, given the extensive prior vascular surgeries, traditional femoral approaches were unable to be utilized. Therefore, a retrograde ipsilateral transpedal approach was chosen as the only remaining possible access site for angiography and intervention. The left anterior tibial artery was cannulated via a 4 French access. The angiogram revealed a total occlusion in the left posterior tibial artery with poor pedal arch flow. Via the 4Fr system, treatment with mechanical thrombectomy, percutaneous transluminal angioplasty, and thrombolysis with tPA was performed and successful restoration of flow to the limb was achieved.