51 year old male with Type 1 Diabetes and a lateral foot ulcer for 4 months. Patient received standard wound care with slow progression of the ulcer and was offered a below knee amputation. Skin perfusion testing showed normal perfusion. CT angiography demonstrated severe stenosis at the origin of the anterior and posterior tibial arteries with variant pedal artery anatomy. Catheter angiography underestimated the degree of stenosis. Intravascular US was performed which clearly showed the degree of luminal loss. Stenting with drug eluding stents was performed. Ulcer healing was achieved 3 months after revascularization.
Review of the clinical findings and their usefulness in identifying patients with peripheral arterial disease
87 year old with severe left leg claudication limiting ability to walk more than 100 feet
38 year old female with severe post thrombotic syndrome and severe venous ulceration for 8 years