Peripheral Vascular Disease

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Step 1: View clinicals

A 69 year old man presents with acute pain in the left foot for 3 days, which rapidly worsened over time. The pain is present at rest and is not relieved by hanging the foot down. During the previous year, he experienced 'tightening' pain in the left calf after walking short distances, with complete relief following stopping and resting. He was diagnosed with diabetes 10 years ago, with satisfactory control. He is a heavy smoker, with a pack history of 30 years.


Step 2: Order all relevant investigations

Full blood count

WBC/DC: 7,000/mm3 Hb: 13.3 g/dL Hct (PCV): 40% Platelets: 300,000/mm3

Duplex Ultrasonography/LL

There is diffuse narrowing of both right and left external iliac arteries, with evidence of poststenotic turbulence. There is absence of flow in the left common femoral artery.

Urea & Creatinine

Blood Urea: 30 mg/dl (0 - 50) S. Creatinine: 0.8 mg/dl (0.5 - 1.5)

Contrast CT Angiogram/LL

There is diffuse stenosis of the right and left external iliac arteries (55% and 85% respectively). Contrast flow up to the midpoint of the left common femoral artery is noted, at which point there is an abrupt cutoff.


Step 3: Select appropriate management

Aspirin
Statins
Surgical thrombectomy
Avoid exercise


Score: ★★☆