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.
Robotic lymph node dissection for prostrate cancer staging with severe leg swelling after
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
87 year old male with a right groin pseudoaneurysm due to the dehisences of the fabric of an aorto bifemoral bypass graft