2026 Volume 7 Issue 3 Pages 298-302
A 100-year-old woman was admitted to our hospital because of rest pain in the right lower leg due to chronic limb-threatening ischemia（CLTI）. She had a 6-month history of CLTI with gangrene of the right first toe. Despite receiving optimal medical treatment, her pain progressively worsened. At the time of the initial presentation at our hospital, the WIfI score was W2I3fI0, ABI was not measurable, and vascular ultrasound showed patency of the deep femoral artery but chronic total occlusion of the superficial femoral, popliteal, and calf arteries. Considering her general condition, age, and cognitive function, it was decided that neither revascularization nor limb amputation was feasible. After successful sciatic nerve block, ultrasound-guided percutaneous Smithwick peripheral nerve block was performed for longer-term pain relief. A 6% phenol solution was injected into the superficial peroneal, deep peroneal, saphenous, and posterior tibial nerves, resulting in complete pain relief. Although she required a second procedure after four months for recurrent pain, she maintained adequate pain control. Ultrasound-guided percutaneous Smithwick peripheral nerve block was suggested as one of the palliative care options for patients with CLTI.
