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Below-the-knee peripheral arterial disease more often presents as critical limb ischemia. Endovascular revascularization strategies continue to evolve to achieve long-term limb-salvage outcomes. A single-center experience with optical coherence tomography-guided atherectomy using Pantheris SV (Avinger) is reported.

This case demonstrates the need for caution when using a collagen-based closure device as bailout for failure of suture-based devices in large-diameter arterial access.