Teaching Case

Stenosis of distal popliteal artery with only one remaining lower thigh artery

Patient suffered from rest pain of his right leg (stage III Fontaine). He presented with a long-term history of diabetes and was a smoker. Angiography revealed no lesion of the iliac or femoral arteries but a tight stenosis of the distal popliteal artery (Fig.1). Additionally, the anterior tibial artery was the only artery preserved in his lower leg while the posterior tibial and the interosseal artery were occluded; the anterior tibial artery was patent down to the foot.

Balloon dilation was performed by use of a hydrophilic 0.035 in guidewire that was gently inserted into the anterior tibial artery. A 3 mm balloon was then advanced over the wire to dilate the stenosis. Post PTA angiography shows successful recanalization without dissection (Fig. 1 b). PTA of the lower limb arteries is generally indicated if a stage IV disease is present. In that special case, some circumstances justified interventional treatment also in a less sever stage. The stenotic lesion was located in the sole outflow tract supplying the lower thigh with a single outflow vessel and no major collaterals were present. In case of increasing disease, the limb would have been definitely at risk and treatment would be then more difficult. In general, it is, however, true that in case of complications following PTA , the situation would have been surely difficult to solve. Thus, an in-depth informed consent is mandatory prior to the intervention.