March 27, 2015 at 7:24 am #7628
A 37 year old male with uncontrolled Type I diabetes, smoker, and hypertension. Has a history of CABG (coronary artery bypass grafting) at age 29.
Presented to ER with leg pain. He had black toes on the left lower extremity. CT angiogram showed severe peripheral arterial disease at popliteal artery and BTK (below the knee) vessel. Swabs returned MSSA. A peripheral angiogram was performed with access at right femoral artery. He was found to have 99% proximal popliteal stenosis. After taking my scout angiography, low and behold acute vessel closure of the popliteal artery. Was it embolized atheroma? Was it acute closure from thrombus (clot)? I did not know, but a semi urgent case, now became an emergency. A wire was finally navigated successfully across the popliteal artery and into the disease anterior tibial artery. Popliteal was revascularized, followed by anterior tibial artery. The peroneal artery was opened with Crosser and then ballooned. Good case, but pucker factor was definitely there.
See, I perform procedures in Rural Town, USA. There are no vascular surgeons, no cardiothoracic surgeons, and very limited subspecialists. I was called at 10pm because the patient wanted to smoke. Um, you almost lost your leg, and you want to…smoke? Can you wait a little bit longer – like until tomorrow. Cannot afford the increase in general inflammation and bad mediators that may close off your leg. It only took me 3 hours with 20lb lead on my back to save your leg. Thanks.
A sick 37 year old diabetic patient had a semi emergency because he had poor blood flow to his legs. He had black toes. He had a bad infection. He was found to have 99% blockage at the main artery that supplies his leg, especially below the knee. The artery shut down completely after taking pictures with a catheter based procedure. It was difficult to find the opening with a completely blocked artery because the vessel cannot be seen. Add the pressure that he may lose his leg if the artery is not opened right away. The artery was finally opened as well as the other arteries below his leg that had severe blockages.
Four hours after the procedure, I was called by the nurse because the patient wanted to go out and smoke. Smoking causes an acute inflammation and may re-shut down his leg since the arteries were only ballooned and not stented.
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