78-year-old male presents with critical limb ischemia. Angiography showed an occluded distal right anterior tibial (AT) artery extending into the dorsal pedal (DP) artery. Antegrade guide wire would not cross the AT occlusion. The occlusion was crossed in a retrograde fashion via DP access, however, the wire deviated posteriorly into the peroneal (Pr) artery. IVUS imaging confirmed an anomalous connection between the Pr and distal AT followed by a successful percutaneous intervention of the DP/AT/Pr arteries.
All authors: John D. Corl, MD, FSCAI and Mitul P. Patel, MD, FSCAI
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