101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot. CT Angiography showed multilevel peripheral arterial disease. No physiologic testing was done. Patient told the pain was due to an ingrown toe nail and sent home on narcotics. The patient went to podiatry and was correctly diagnosed as having critical limb ischemia.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Iliac vein compression may cause pelvic venous congestion.
Percutaneous bypass graft for severe critical limb ischemia