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Figure 1: Primary angioplasty approach in a diabetic critically ischemic, but non-neuropathic left foot and ankle ulcer: a) The initial severe calf arteries lesions: the Anterior and Posterior tibial arteries are occluded. The Peroneal artery is the only supplying vessel to the foot; it shows severe, sub-occlusive and multi-level atherosclerotic stenosis pointed by the two arrows. b) The arteriographic result after staged angioplasties in the Peroneal artery, allowing a correct flow to the lower ankle (upper arrow). Via its anterior communicants, the Peroneal indirectly fills the left Dorsalis Pedis artery and further the foot arches by retrograde flow (lower arrow). c) Initial clinical presentation of the left foot ulcer. d) The clinical result at five months, with correct healing, by sharing a multidisciplinary team approach that covers both, the ischemic and the neuropathic aspect of the wound. |