Intravascular Ultrasound Guided Puncture of Stumpless Tibial Occlusions

This report describes a novel technique using intravascular ultrasound (IVUS) to guide revascularization of a stumpless posterior tibial artery occlusion in a patient with chronic limb-threatening ischemia. After failed attempts at both antegrade and retrograde access, IVUS was employed to identify and mark the exact location of the posterior tibial artery ostium. Using this guidance, successful wire cannulation was achieved, confirmed intraluminally with IVUS, followed by balloon angioplasty and restoration of brisk in-line flow through the posterior tibial and lateral plantar arteries. This intervention ultimately led to complete wound healing and avoided a major amputation. In conclusion, this IVUS-guided technique offers a safe and effective approach for revascularizing challenging stumpless tibial occlusions, expanding the tools available for limb salvage in complex peripheral artery disease.