The clinical evaluation of peripheral arterial disease (PAD) is difficult and yet critically important so that patients receive the care they need. The greatest problem is that clinical evaluation is limited in excluding significant PAD. In short, none of the various clinical findings have a high negative predictive value for PAD. Even simple pulse palpation is fraught with error. All patients with non healing ulcers or wounds or with exertional leg pain should undergo objective physiologic testing.
The tip of a hydrophilic wire was fractured and subsequently retrieved during the crossing of a distal anterior tibial artery near occlusion
59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe.
38 year old female with severe post thrombotic syndrome and severe venous ulceration for 8 years