44 year old female with an extensive history of PAD with multiple PTAs, prior amputations of left 4th and 5th toes, HTN, DM, CAD with MI, CABG, PCIs, severe left ventricular systolic dysfunction, left CEA, multiple CVAs presents with critical limb ischemia – Non-healing right foot ulcer. His lower extremity angiogram reveals a severe distal right common femoral arterial lesion, a long right superificial femoral artery chronic total occlusion and severe infrapopliteal run-off.

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