Case Presentation ALIREZA SADEGHI MD Brooklyn VA Medical Center SUNY Downstate Medical Center Case Presentation • xx Year Old African-American Male • Referral: Podiatry • Chief Complaint: – History of ½ Block Claudication (RLE) – New Onset Rest Pain: • Right Lower Extremity x 3 months – Tissue Loss: Non Healing Ischemic Ulcer x 2 months • Plantar Surface Right 1st Toe Case Presentation • Medical History – BPH – HTN – EtOH Abuse – IDDM – Tobacco Use – CAD • Current: xx Pack Yrs – MI x 2 – Glaucoma – CHF – Obesity – COPD • Surgical History – Hyperlipidemia – Appendectomy xx years – Rheumatoid Arthritis prior – Osteoporosis Case Presentation • Medications – Insulin (NPH/Regular) – Coreg – Prednisone – Lisinopril – Sulfasalazine – Lasix – Terazosin – Spirinolactone – ASA – Zocor – Multivitamins – Fosamax – Calcium Carbonate • NKDA – Albuterol MDI – Ipratropium MDI Case Presentation • Laboratory Values : • Na: 142 • WBC: 7.0 • HGB: 13.3 • K: 4.4 • HCT: 41.7 • Cl: 107 • PLT: 206 • CO : 28 2 • BUN: 10.0 • Creat: 1.0 • PT: 13.7 • Gluc: 72 • PTT: 28.1 • Ca: 8.2 • INR: 1.1 • LDL: 207 Physical Examination • Vital Signs • Physical Exam – Temp: 98.6 F – A & O x 3 – BP: 127/64 – No carotid bruit – HR: 75 – CTA B/L; RRR – RR: 18 – + JVD at 30 Degrees – O Sat: 95% RA – Abd: No pulsatile mass 2 – Extremities: • Pulses: – 2+ Femoral B/L – Nonpalpable Pop/DP/PT B/L • 2 x 2 cm non healing ischemic ulcer on R 1st toe. PVR Severe Multi-level Occlusive Disease Angiogram Angiogram Operating Room • Percutaneous Entry Technique: – Contralateral Femoral Artery Cannulation – Cross-Over Sheath Placed – 0.014’ wire passed through the lesions