Botulinum toxin type A (BoNT/A) is a potent neurotoxin with widely use range, for the good outcomes in the treatment of pain, it was considered as an unique analgesic drugs with the feature of sustained efficacy after a single application, but up to now, treating chronic limb-threatening ischemia (CLTI) with BoNT/A was rarely reported. We present a 91-year-old man with CLTI, the main clinical manifestations were left foot rest pain, intermittent claudication and toe necrosis, the patient refused invasive treatments, and the pain failure to respond to conventional analgesic drugs, the subcutaneous injections of BoNT/A was performed to the patient. The pain score on the visual analog scale (VAS), decreased from 5-6 (before treatment) to 1 within days after infiltration, and keep in 1-2 of VAS during follow-up. Our case report demonstrated that BoNT/A may be an unique minimally invasive solution for treating rest pain in CLTI.

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