Dr Abadir Critical Limb Ischemia Case

Dr. A. Ramsey Abadir is board certified by the American Board of Radiology in Diagnostic Radiology, with a certificate of added qualification in Vascular & Interventional Radiology.

Patient History and Consultation

82 year-old male with painful blistering ulcerations on the anterior surface of the left lower leg progressively worsening over 4 months despite wound care. Pt also complains of “tiredness” in the left leg on ambulation. No distal pulses palpable. History of stent placement in left leg.

Past Medical History

• Coronary Artery Disease s/p CABG and coronary stents
• HTN
• Atrial fibrillation
• PVD
• Prior smoker

Medications Include

• Metoprolol
• Lisinopril
• Coumadin

Treatment Plan

The patient started with a Preliminary Evaluation

• Lab evaluation: Lipids
• Start Statin Therapy
• Discuss with cardiology re: changing from Coumadin to antiplatelet therapy
• Arterial duplex:
  Diffuse disease with 75% stenosis of proximal SFA, occluded Anterior Tibial artery and slow monophasic flow in Posterior Tibial and Peroneal Artery 

Angiography with angioplasty/atherectomy and stent as needed. 

(Image above –Proximal SFA stenosis treated with atherectomy and angioplasty)

(Image above – Occluded ATA and poor collateralization)

(Image above – Post atherectomy and angioplasty and Restored patency of AT)

(Image above – Wounds have progressively healed and Pain in leg significantly improved)