64 year old female with a 2 year history of worsening left calf claudication. Pain has become severe enough the patient is having a hard time working and staying employed. CT angiography showed a heavily calcified common femoral artery plaque causing near occlusion of the artery. Retrograde superficial femoral access with directional atherectomy was attempted but limited due to difficulty getting the cutting blade to engage the plaque. Using external compression to assist the atherectomy resulted in significant plaque removal and luminal gain. Patient had normalization of their ABI's and was able to work pain free 2 days after the procedure.
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft.
94 year old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.