Woman with Leg Pain

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

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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. 

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

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(Image above – Occluded ATA and poor collateralization)

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

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

Learn more about vascular health, prevention, and care for Peripheral Artery Disease.

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