Takafumi Fujita, Makoto Sugihara, Kaori Mine, Tetsuo Hirata, Yasunori Suematsu, Takashi Kuwano, Shin-Ichiro Miura
A 50-year-old man with type 2 diabetes mellitus was admitted for chronic limb-threatening ischemia (CLTI). Ulcers involved several toes on both feet. Angiography of the left lower extremity demonstrated severe below-the-ankle arterial disease with markedly compromised pedal runoff. After unsuccessful endovascular therapy of the left lower extremity, low-density lipoprotein (LDL) apheresis was initiated for limited-option CLTI. An increase in microcirculatory flow in the left foot was observed after LDL apheresis, as assessed by angiography and GOKO Bscan-ZD. Complete wound healing was achieved after a transmetatarsal amputation. GOKO Bscan-ZD may represent a novel noninvasive method with which to evaluate microcirculation.