MEDizzy - A 58-year-old man presents with pain in the left leg after

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Peripheral Vascular Problems

A 58-year-old man presents with pain in the left leg after walking more than one block that is relieved with rest. On physical examination, distal pulses are not palpable in the left foot and there is dry gangrene on the tip of his left fifth toe. An ankle-brachial index on the same side is 0.5. Which of the patient’s symptoms or signs of arterial insufficiency qualifies him for reconstructive arterial surgery of the left lower extremity?

ExplanationD. The major threat to patients with arterial occlusive disease is limb loss. Rest pain and gangrene represent advanced stages of arterial insufficiency and warrant arterial reconstructive surgery whenever clinically feasible. This patient does not have rest pain which is defined as persistent pain in the extremity. Claudication, in most cases, reflects mild ischemia; the majority of affected patients are successfully managed without surgery. Most will stabilize or improve with development of increased collateral blood flow following institution of a program of daily exercise, cessation of smoking, and weight loss. Ankle-brachial index is a useful preoperative tool but does not by itself determine whether someone is a candidate for revascularization. Palpable pulses are usually absent in patients with claudication. Vasodilator drugs have been shown to have little benefit in the conservative management of intermittent claudication.