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.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.
51 year old female with a long history of low back pain, pelvic aching and heaviness, urinary frequency and painful intercourse.
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.