I thought I’d spend the month of April thinking about vascular screening.
Last week I saw a 55-year-old man who suffered a minor scratch on his left shin 6 months earlier. He is a heavy smoker. Before the injury his walking was limited by claudication. After the injury his leg began to worsen and he began sleeping in the recliner due to rest pain. By the time I saw him he had so much ischemic pain he was not able to lie completely flat for TCOM testing. With slight dependency during the examination, the transcutaneous oximetry value of his foot was low at 35 mmHg. There was a right anterior leg ulcer with possible tendon exposure. In this photo the wound is covered by a collagen dressing. I explained that he had ischemic rest pain and that this was a vascular emergency. He then admitted that he had seen a vascular surgeon in the past and had been told he might need a bypass. Next week we will talk some more about the oxygen challenge and what happened.