Case and Plan
67-year-old male referred for progressively worsening LLE claudication progressing to rest pain over the past 6 months (Rutherford category 4)
•Worsening symptoms despite maximal medical therapy and community based SET
•PMH: HTN, HLD, CAD s/p CABG (LIMA-> LAD), Ischemic cardiomyopathy (EF 30%) S/P AICD , Infective endocarditis s/p bioprosthetic MVR, h/o DVT
•Medications: Sacubitril-Valsartan (49-51), VKA, Rosuvastatin 40 mg, Ezetemibe, Carvedilol 12.5 mg BID, Furosemide, clopidogrel
•Social History: Nonsmoker
•Physical Exam:
•No carotid or abdominal bruits
•Palpable DP and PT 1+ bilaterally
•Resting ABI : O.64 (R) 0.50 (L)
•Lower Extremity Dupex:
•Total occlusion of mid popliteal artery with reconstitution of flow in distal popliteal artery
•Distal AT and PT patent with diminished flow
•CT angiogram of LLE:
•Occluded mid to distal segment of the left popliteal artery and TP trunk with three vessel infra-popliteal reconstitution via collaterals
