62 year old male, heavy smoker, with a long history of leg pain with exertion. Under went spinal fusion with no improvement in symptoms. Exercise ABI's demonstrated severe peripheral arterial disease. CT angiography showed occlusion of the infra renal abdominal aorta, bilateral common iliac arteries, left external iliac artery and severe disease of the right external iliac artery. Recanalization was difficult and ultimately accomplished using a sharp reentry technqiue with a Chiba needle into the abdominal aorta. Covered endografts were used to treat the patient. ABI's were normalized post procedure.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia