A 52-year-old man complained of pain and cramping in his right calf
caused by walking two blocks. The pain was relieved with cessation of
activity. The pain had been increasing in frequency and intensity.
Physical examination findings were essentially normal except for
decreased hair on the right leg. The patient’s popliteal, dorsalis
pedis, and posterior tibial pulses were markedly decreased compared with
those of his left leg.
Studies Results Routine laboratory work Within normal limits (WNL)
Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90
mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal:
same as brachial systolic blood pressure) Arterial plethysmography
Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and
posterior tibial pulse waves Femoral arteriography of right leg
Obstruction of the femoral artery at the midthigh level Arterial duplex
scan Apparent arterial obstruction in the superficial femoral artery
Diagnostic Analysis With the clinical picture of classic
intermittent claudication, the noninvasive Doppler and plethysmographic
arterial vascular study merely documented the presence and location of
the arterial occlusion in the proximal femoral artery. Most vascular
surgeons prefer arteriography to document the location of the vascular
occlusion. The patient underwent a bypass from the proximal femoral
artery to the popliteal artery. After surgery he was asymptomatic.
Critical Thinking Questions 1. What was the cause of this patient’s
pain and cramping? 2. Why was there decreased hair on the patient’s
right leg? 3. What would be the strategic physical assessments after
surgery to determine the adequacy of the patient’s circulation? 4. What
would be the treatment of intermittent Claudication for non-occlusion?
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Peripheral Vascular Disease. Case Studies was first posted on November 5, 2020 at 11:05 am.
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