Dr. Shams Case Study Overview – Amputation Prevention


Dr. Joseph Shams, an interventional radiologist at American Endovascular and Amputation Prevention. In today’s case study, we are going to talk about a non-healing wound and how we were able to prevent amputation. Saving limbs that others cannot.

Patient History and Consultation

38 year old, 300 lb male presents with large poorly healing ulceration of his left heel. Ulceration has been present for > 6 months prior to consultation with our service. The patient suffers from a skin condition hidradentitis suppurativa and cannot be touched in either groin.

Past Medical History

  • HTN
  • DM
  • Hyperlipidemia
  • CAD S/P MI
  • ESRD on HD

Medications Include

  • Citalopram
  • Renagel
  • Januvia
  • Atorvastatin
  • zinc sulfate
  • Clindamycin HCl
  • Rifampin

Treatment Plan

The patient started with a diagnostic workup, which included:

  • Lab evaluation
  • Begin anti-platelet therapy
  • Arterial imaging/doppler
  • Limited secondary to patient body habitus and inability to tolerate the exam

Angiogram and planned revascularization via left brachial artery, transpedal, and transpopliteal artery routes.

(Image above – Poorly Healing Left Heel Ulcer)

Initial lower extremity angiogram from left brachial artery approach through the patient’s left upper arm AV fistula.

Lower Extremity Angiogram via Left Arm Approach

(Image above – Lower Extremity Angiogram via Left Arm Approach)

Left Lower extremity Angiogram- Focal Distal SFA Stenosis

(Image above – Left Lower extremity Angiogram- Focal Distal  SFA Stenosis)

LLE Angiogram – AT runoff with proximal and distal stenoses, diffusely attenuated peroneal and PT arteries

(Image above – LLE Angiogram – AT runoff with proximal and distal stenoses, diffusely attenuated peroneal and PT arteries)

S/P Atherectomy with 1.25 mm CSI and angioplasty of SFA and AT stenoses via AT Transpedal Approach

(Image above – S/P Atherectomy  with 1.25 mm CSI and angioplasty of SFA and AT stenoses via AT Transpedal Approach)

Improved distal runoff with limited flow to area of ulceration

(Image above – Improved distal runoff with the limited flow to the area of ulceration)

Selective LLE Angiogram ( 5 days later) Via Antegrade Popliteal Artery Approach-diffusely diseased and attenuated peroneal artery, occluded PT artery

(Image above – Selective LLE Angiogram ( 5 days later) Via Antegrade Popliteal Artery Approach-diffusely diseased and attenuated peroneal artery, occluded PT artery)

Diffusely Diseased Distal Runoff

(Image above – Diffusely Diseased Distal Runoff)

S/P CSI Atherectomy and Angioplasty of Peroneal Artery Stenoses

(Image above – S/P CSI Atherectomy and Angioplasty of Peroneal Artery Stenoses)

Brisk Flow to Area of Ulceration

(Image above – risk Flow to Area of Ulceration)

Before and After Images-Left Heel Ulceration

(Image above – Before and After Images-Left Heel Ulceration)

Request a consultation at your nearest American Endovascular center today.