55 year old female with a skin lesion removed from the posterior calf. Lesion turned out to be a basal carcinoma. 7 weeks after the surgery, the patient had a large area of ulceration with copious drainage of fluid. The patient returned to the physician that did the procedure was told to continue changing dressings and that the ulcer would eventually heal. The patient came to see me and underwent a venous ultrasound showing incompetence of the small saphenous vein. The small saphenous vein is connected to the popliteal vein and the calf muscle pump. When the small saphenous vein is incompetent the skin is subjected to the extremely high pressures generated by the calf muscle pump. Treatment resulted rapid healing of the ulcer.
Percutaneous bypass graft for severe critical limb ischemia
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
38 year old female with severe post thrombotic syndrome and severe venous ulceration for 8 years