61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable. No dorsalis pedis artery pulse. Monofilament testing showed decreased sensation typical of diabetic neuropathy. Angiography showed distal PTA stenosis and severe stenosis in the proximal lateral plantar artery - the blood supply to the wound. Interestingly, the anterior tibial artery had variant anatomy where it terminates into medial and lateral tarsal branches with no true dorsalis pedis artery. This variant has been noted to predispose the foot to ischemia.
62 year old female with 2 months of short distance claudication and rest pain at night
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.