A down hill puncture was performed and diagnostic angiography obtained, demonstrating:

1. moderate to high grade focal stenosis in the SFA with a more general region of narrowing distal to it. 
2. occluded anterior tibial distal to its origin
3. trickle flow only though tight long segment stenosis of the posterior tibial artery, from mid calf to ankle joint. 

5000 units of heparin were administered and angioplasty of the SFA performed over a 0.035 wire using a 5 x 40 mm Admiral xTreme (Medtronic) angioplasty balloon. 

The wire was exchanged for a 0.014 floppy tip wire, which was passed through the PTA stenosis down to the ankle joint. A 2 x 120 mm angioplasty balloon was then used to angioplasty approximately 20 cm of vessel with excellent angiographic result.