Abstract
Peripheral arterial disease (PAD) causes progressive arterial narrowing that limits blood flow to the limbs, often resulting in pain, non-healing wounds, and risk of amputation. In advanced cases without distal arterial targets, conventional revascularization is not feasible, necessitating alternative strategies. We report the case of a 68-year-old man with diabetes and advanced PAD who presented with foot necrosis. Angiography revealed complete occlusion of the anterior tibial, posterior tibial, and peroneal arteries, with no distal runoff. After unsuccessful angioplasty, an endovascular arteriovenous fistula was created between the posterior tibial artery and the plantar venous system to restore perfusion. Despite postoperative complications, including infection, the patient demonstrated progressive improvement after partial amputation, achieving complete wound healing by 25 weeks. This case highlights endovascular arterialization of the venous plantar arch via the posterior tibial artery as a promising limb-salvage technique for patients without conventional revascularization options.