62 year old female, heavy smoker, noticed a relatively sudden worsening of chronic right calf claudication. Ultrasound and CT angiography demonstrated occlusion of the common femoral artery. The patient is overweight with a body mass index of 35. The patient was self employed and did not want, nor could afford the time off work to under go a common femoral endarterectomy. Endovascular repair with pathway atherectomy in a 60 minute procedure. Patient spent a total of 4 hours at our out patient center and was back at work the next day. At 6 months, the patient has stopped smoking, and remains symptom free. Optimal medical therapy with blood pressure control, statin and dual antiplatelet therapy. Arterial ultrasound shows a widely patent CFA and exercise ABI's are essentially normal.
30 year old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral DVT.
71 year old female with a non healing ulcer on the left foot.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.