Peripheral Arterial Disease Hall of Shame – Case #2

Here is another installment in my “Peripheral Arterial Disease Hall of Shame.” This is an alert woman in her 90’s who still lives alone. She has had a circumferential leg ulcer for 4 years and chronic pain. She has been to a series of physicians and some months prior was admitted for IV antibiotics because of her “cellulitis” (the red color of her leg from the knee down). The redness did not improve with antibiotics. She was put in compression wraps at another wound center.

Photo1_IMG_7701Because her foot and leg were edematous, she was referred to one of the local vein centers and underwent a venous ablation procedure, after which she was placed in a compression stocking. Her neighbor brought her to the Wound Clinic where she was found to have a skin perfusion pressure in single digits and a flat pulse volume recording. She was emergently admitted to the hospital and the following day, an invasive cardiologist stented her severe iliac artery occlusion. Over a period of weeks, she healed with gentle compression. I like to use Coban 2 layer LIGHT in these patients. It’s only 20 mmHg of compression but in her case that was enough. This little lady was able to continue living independently.

There are wound care clinicians who feel they have to wait for arterial Doppler’s in order to put a patient in compression. However, the POINT of having the ability to do ABIs, SPP or transcutaneous oximetry is to screen patients in the clinic and make a decision right then as to whether they need an angiogram or whether they can be put into compression immediately. Coban 2 layer LIGHT is very safe.

Although this sweet lady did not have diabetes, she did have a major risk factor for arterial disease – namely — advanced AGE. Nevertheless, none of the half dozen clinicians who saw her thought to do an arterial screen. Why is this so hard?

Take a look at the first photo. Why is her leg red? (It is NOT warm to the touch.)

Photo 1: Ischemic rubor from just below the knee on her first visit. She’s had the circumferential ulcer for nearly 4 years.

Photo 2: About 2 weeks after revascularization. The redness is improved and her wound is already healing.

Photo 3: Finally healed after gentle compression.

Check out this article on arterial  screening.

http://www.todayswoundclinic.com/articles/addressing-need-noninvasive-vascular-testing-outpatient-clinic-case-study