Peripheral Vascular Disease
\nCase Studies
\nA 52-year-old man complained of pain and cramping in his right calf caused by walking two
\nblocks. The pain was relieved with cessation of activity. The pain had been increasing in
\nfrequency and intensity. Physical examination findings were essentially normal except for
\ndecreased hair on the right leg. The patient\u2019s popliteal, dorsalis pedis, and posterior tibial
\npulses were markedly decreased compared with those of his left leg.
\nStudies Results
\nRoutine laboratory work Within normal limits (WNL)
\nDoppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg;
\nposterior tibial: 88 mm Hg; dorsalis pedis: 88
\nmm Hg (normal: same as brachial systolic
\nblood pressure)
\nArterial plethysmography Decreased amplitude of distal femoral, popliteal,
\ndorsalis pedis, and posterior tibial pulse waves
\nFemoral arteriography of right leg Obstruction of the femoral artery at the midthigh
\nlevel
\nArterial duplex scan Apparent arterial obstruction in the superficial
\nfemoral artery
\nDiagnostic Analysis
\nWith the clinical picture of classic intermittent claudication, the noninvasive Doppler and
\nplethysmographic arterial vascular study merely documented the presence and location of the
\narterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography
\nto document the location of the vascular occlusion. The patient underwent a bypass from the
\nproximal femoral artery to the popliteal artery. After surgery he was asymptomatic.
\nCritical Thinking Questions
\n1. What was the cause of this patient’s pain and cramping?
\n2. Why was there decreased hair on the patient’s right leg?
\n3. What would be the strategic physical assessments after surgery to determine the
\nadequacy of the patient’s circulation?
\n4. What would be the treatment of intermittent Claudication for non-occlusion?<\/p>\n","protected":false},"excerpt":{"rendered":"
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