59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe. Comprehensive workup for an embolic source demonstrated a focal plaque in the popliteal artery. Catheter angiography showed the ulcerated plaque. Directional atherectomy using a SilverHawk atherectomy device was performed. Patients symptoms resolved and at last follow up 2 years later, the patient had no recurrence.
22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT).
46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.