Fig. 10.

Representative case of staged procedures for multisegment disease presenting with tissue loss. a A 71-year-old male presenting with unhealing ulcer on the right second toe. Foot SPP was not measurable because of serious foot pain. b Enhanced CT revealed multisegment disease including occlusions in the right extrenal iliac (thin arrow) and femoropopliteal arteries (thick arrows). c Enhanced CT also revealed extensive occlusions in the right anterior tibial and peroneal arteries. d In the first session, right external iliac artery occlusion was successfully recanalized with stents. Given the concomitant femoropopliteal lesion complexity, contrast volume used, and procedure time, long occlusion in the femoropopliteal artery remained untreated in the session. Although rest pain significantly improved, the wound did not significantly heal with the foot SPP only 25 mmHg on the dorsum and 15 mmHg on the plantar, suggesting the need for further intervention. e In the second session, long occlusion in the right femoropopliteal artery was successfully recanalized with stents. However, given the potential of balloon-induced early reocclusion in the crural artery, the concomitant infrapopliteal artery remained untreated. f Foot SPP increased to 77 mmHg on the dorsum and 70 mmHg on the plantar, and the wound completely healed 5 months later