The patient was initially seen for ischemic ulceration of right foot toe ulcers and was found to have 2 left popliteal artery aneurysms. The patient declined treatment of the aneurysms at that time. 18 months later the aneurysms occluded and the patient developed ulcerations of several left toes with rest pain. Revascularizion was performed using a Jetstream atherectomy of the occluded popliteal artery and stenting. Drug eluding stenting of the proximal anterior tibial artery severe stenosis. Ulcer healing occurred and the patient is doing well 21 months later.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Renal vein stent placed for Nutracker Syndrome was placed too far into the IVC and causing pain. Stent was partially removed.