Lower extremity revascularization with iatrogenic embolization

The patient presented with a popliteal artery occlusion (arrow; A). During recanalization and percutaneous angioplasty of the popliteal artery, embolization to the distal posterior tibial artery was apparent (dashed arrow; B). Attempted aspiration of the thrombus using an Angiojet was not successful; the angioplasty site remained patent (asterisk; B). An infusion catheter was placed into the popliteal artery for overnight thrombolytic therapy, which was not successful. The thrombus extended into the tibioperoneal trunk (thick arrow; C). The infusion catheter was moved into the tibioperoneal trunk. With additional thrombolysis in conjunction with administration of a IIb/IIIa inhibitor, the thrombus resolved with reestablishment of pedal flow (D). Residual stenosis was treated with drug-eluting stents with good post-stenting flow (E). The asterisks and arrowheads demonstrates similar anatomic locations on each angiogram.