86 year old male had a recurring ankle ulcer that was being managed with local wound care only. Eventually, an MR angiogram was obtained showing severe tibial artery disease. Skin perfusion pressures showed decrease perfusion but with values suggesting wound healing was obtainable. Further evaluation with venous ultrasound showed incompetence in the great saphenous and small saphenous veins with an incompetent distal calf perforater. The lack of visible varicose veins should not preclude evaluation for venous disease. This is a common misperception -> the lack of typical findings of venous disease means there is no venous disease. All ulcers around the ankle are venous until proven otherwise. The patients incompetent veins were treated, pain resolved and the patient's ulcer at 3 weeks was rapidly improving.
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation.
Endovascular therapy of external iliac and common femoral artery occlusion with 31 month follow up
59 year old male with short distance exercise induced left leg pain. Pain was severe and was interfering with the patients actively living.