Endovascular Management of Non-Healing Leg Ulceration
A 72 year old non-smoking female with a past medical history of hypertension, well-controlled diabetes, and stable coronary artery disease, status post CABG with bilateral great saphenous vein harvests, presents to her podiatrist. She developed an ulcer over the right first metatarsal head after wearing a new pair of shoes approximately 4 months ago. The wound is gradually getting larger, despite appropriate local wound care and off-loading procedures. She is referred to you for evaluation for arterial insufficiency.
Physical examination reveals normal and equal bilateral femoral pulses with no palpable distal pulses. There are well-healed, bilateral medial thigh incisions. The toes are pink with brisk capillary refill. There is diminished sensation to fine touch bilaterally, but normal motor function is noted. The ulcer base is pale with fibrinous debris. There is no foul odor or obvious cellulitis.
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