Figure 5d.

Third-degree frostbite of the right foot in a 45-year-old woman. (a) Dorsal photograph shows diffuse swelling of the midfoot and toes, with both clear and hemorrhagic blisters. (b) DSA image obtained at presentation shows occlusion of the first through fifth digital arteries. (c, d) DSA images obtained after 12 (c) and 36 (d) hours of continuous intra-arterial tPA infusion via the tibioperoneal trunk show restoration of perfusion in the first and second toes, with continued diminished perfusion of the distal third through fifth toes. The patient’s foot ultimately healed without surgical intervention.