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
46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle.
Ultrasound of Incompetent SaphenoFemoral Junction Valve