59 year old male with short distance exercise induced left leg pain. Pain was severe and was interferring with the patients actively living. He was seen and treated for neurogenic claudication for several months without any improvement. The patient had palpable pulses in the left foot which was mistaken as indicating he had good blood flow to the leg. There is a common misconception that pulses in the foot means that there is no significant peripheral arterial disease. All patients with exertional leg pain (pain when walking) need to be evaluated with an exercise ankle brachial index study (ABI). In 1 hour, the patient was treated and was able to resume referring soccer games 48 hours later.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia