83 year old male, Type I Diabetes, end stage renal disease, living independently who was told he needed a below knee amputation. The patient had a failed popliteal to dorsalis pedis artery bypass graft. An attempt at endovascular repair also failed. The patient came for a second opinion. A second at endovascular repair was successful. The patient had a transmetarsal amputation which healed. He continued to live on his own for another 4 years, enjoying his life with both legs.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Painful varicoceles interfering with high school athletics