A 71-year-old male patient was admitted because of gangrene in his left foot. Diabetes mellitus was diagnosed on admission and he was treated with low doses of insulin. Antibiotic therapy was initiated, in addition to pentoxyphillin, prostaglandin E1 synthetic analog and phentanyl for the pain. A digital subtraction angiography was carried out which disclosed multiple sites of stenosis in both iliac and superficial femoral arteries (Figure 7.16 upper panel, and Figure 7.17). A suboptimal angioplasty was carried out on both arteries and stents were inserted (Figure 7.16 lower panel, and Figure 7.18).

During percutaneous transluminal angio-plasty a balloon catheter is used to increase the diameter of the lumen of the arterioscle-rotic artery. This is a quite safe and minimally invasive technique (as compared to surgery); it preserves saphenous veins, and reduces the length of hospital stay. However, this procedure fails more often in diabetic than in non-diabetic patients due to intimal hyperplasia.

Stents are used to treat suboptimal angio-plasty, lesions with severe dissections or

Figure 7.11 Post-stent digital subtraction angiography of foot shown in Figures 7.7-7.10. (Courtesy of C. Liapis)

Figure 7.11 Post-stent digital subtraction angiography of foot shown in Figures 7.7-7.10. (Courtesy of C. Liapis)

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Figure 7.12 Dry gangrene of right fourth toe. There is a neuro-ischemic ulcer under the third metatarsal head
Figure 7.13 Digital subtraction angiography of the foot shown in Figure 7.12. Severe stenosis following the bifurcation of celiac aorta can be seen

significant residual stenosis after angioplasty. The first endovascular stent approved for use in the iliac arteries was the Palmaz stent, a single stainless steel tube, deployed by balloon expansion. The Wall-stent, a flexible self-expanding stent which is available in several different diameter sizes, is also in use. New, covered stents are being evaluated, with the hope that they may mimic surgical grafts and resist re-stenosis.

Keywords: Stents; peripheral vascular disease; angioplasty; digital subtraction angiography

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