Narrowed 2

A 69 year old man presents with acute pain in the left foot for 3 days, which rapidly worsened over time. The pain is present at rest and is not relieved by hanging the foot down.

During the previous year, he experienced 'tightening' pain in the left calf after walking short distances, with complete relief following stopping and resting.

He was diagnosed with diabetes 10 years ago, with satisfactory control. He is a heavy smoker, with a pack history of 30 years.

Select Relevant Investigations
Full blood count

Performed

WBC/DC: 7,000/mm3
Hb: 13.3 g/dL
Hct (PCV): 40%
Platelets: 300,000/mm3
Duplex Ultrasonography/LL

Performed

There is diffuse narrowing of both right and left external iliac arteries, with evidence of poststenotic turbulence. There is absence of flow in the left common femoral artery.
Urea & Creatinine

Performed

Blood Urea: 30 mg/dl (0 - 50)
S. Creatinine: 0.8 mg/dl (0.5 - 1.5)
Contrast CT Angiogram/LL

Performed

There is diffuse stenosis of the right and left external iliac arteries (55% and 85% respectively). Contrast flow up to the midpoint of the left common femoral artery is noted, at which point there is an abrupt cutoff.

Select Relevant Management
Aspirin
Statins
Surgical thrombectomy
Avoid exercise