Percutane subintimale angioplastiek bij een oude vaatpatiënte met kritieke ischemie en een niet-genezend arterieel ulcus aan de voet

A 92-year-old female patient developed an intractable ulcer on the upper side of her right foot after she had dropped a pan on the foot. Non-invasive examination of the vessels revealed severe arterial disease with considerable lowering of the ankle-brachial blood pressure index, the arterial pressure in the A. peronea and low partial pressure of oxygen in the forefoot. The patency of both the A. poplitea and the outflow to the A. peronea and the A. tibialis posterior was restored by means of percutaneous subintimal angioplasty, and the wound healed rapidly after this. Critical ischemia of the lower extremity in elderly patients is often a difficult problem, especially in combination with a non-healing arterial ulcer. Surgical options are often absent or undesirable due to extensive pathology or vascular comorbidity. The main advantages ofpercutaneous treatment are local anaesthesia, short hospitalization and low risk. Short hospitalization is often a major advantage in the elderly. Although we know that the long-term patency after bypass surgery is better than after a percutaneous treatment, the clinical outcome is not different. Broader application of percutaneous subintimal vascular treatment can prevent risky vascular reconstruction operations and amputations in this patient group. In The Netherlands the options for a more extensive percutaneous treatment are few and are only possible in a few hospitals