Modest success can be expected with pedal bypass grafts in patients with ESRD, with most failures occurring in the first 3 months. Limb salvage rates lag behind graft patency rates because of progressive necrosis despite a hemodynamically functioning bypass graft. Heel gangrene is a strong predictor for a negative outcome. Lastly, overall patient survival rates are poor but comparable with the rates of other patients with ESRD.

Purpose: To investigate the short-term clinical outcomes and satisfaction for the first set of patients at our institution receiving in-office needle arthroscopy (IONA) for the treatment of posterior ankle impingement syndrome (PAIS). Methods: A retrospective cohort study was conducted to evaluate patients who underwent IONA for PAIS between January 2019 and January 2021. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System Pain Interference, and Pain Intensity scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. The Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. Results: Ten patients (4 male and 6 female) with a mean age of 41.9 AE 15.5 years (range, 24-66 years) were included in the study. The mean follow-up time was 13.3 AE 2.9 months (range, 11-17 months). All mean preoperative FAOS scores demonstrated improvement after IONA, including FAOS symptoms (71.48 AE 10.3 to 80.3 AE 12.6), pain (69.3 AE 11.0 to 78.2 AE 13.9), activities of daily living (61.7 AE 8.8 to 77.93 AE 11.4), sports activities (55.6 AE 12.7 to 76.0 AE 13.6), and quality of life (46.6 AE 9.2 to 71.1 AE 12.1). There were 7 patients who participated in sports activities before the IONA procedure. Within this group, all patients returned to play at a median time of 4.1 weeks (range, 1-14 weeks). The median time to return to work was 3.4 AE 5.3 days. Patients reported an overall positive IONA experience with a mean rating scale of 9.5 AE 1.5 (range, 5-10). Conclusions: The current study demonstrates that IONA treatment of PAIS results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes. In addition, IONA for PAIS leads to high patient satisfaction with a significant willingness to undergo the same procedure again. Level of Evidence: IV, therapeutic case series.P osterior ankle impingement syndrome (PAIS) is a syndrome involving posterior hindfoot pain due to the impingement of the posterior ankle joint. PAIS can be debilitating, especially in athletes enduring repeated plantarflexion, like ballet dancers, soccer players, and downhill runners. 1 Several factors may contribute to the development of PAIS, including but not limited to variations in soft tissue and bony anatomy, such as an os trigonum or Stieda process. 2 With repetitive plantarflexion, soft or bony tissue may become compressed,

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