Critical Limb Ischemia – Multilevel Disease – May 2018

71 year old female with history of type 2 DM, hypertension, dyslipidemia and stage 3 CKD. No known peripheral vascular disease. Patient was doing well until about 4 months ago, when she noticed an ulcer on her right first toe, associated with pain. She also reports pain in her foot, which is relieved in dependent position. She was evaluated at an outside hospital and after ‘work up’ was told that she needs an ‘amputation’. She was referred by her PCP for a second opinion. Review of work up showed ABI of 0.43 on right and 0.78 on left side. Arterial duplex was reported as subtotal occlusion of the right SFA and occlusion of right AT and PT in mid-segment. On examination, she has a 3 x 2 cm ulcer on the first toe associated with minimal exudate.

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