The patient was a 79 years old male, with NIDDM treated by oral medication. He presented with foot ulcers and a TCO2 in the foot region of 2 mmHg.

We decided to attempt a complete recanalization of the foot since a discrete distal run off was present due to the patency of the anterior tibial artery (Panel A). At the same time improvement of the “in-flow” vasculature could also offer enormous advantage for ulcer healing and patient improvement in life quality. In order to obtain a good recanalization it was therefore fundamental to reopen calcific lesions and long chronic total occlusion of sub-popliteal vessels. We utilized a left common femoral ipsilateral antegrade approach and after placement of a 6Fr sheath introducer, a popliteal PTA was performed utilizing a 6 mm balloon. Then, the origin of the...continua a leggere