This is another installment of the Peripheral Arterial Disease Hall of Shame. You may be getting tired of these cases, but since I see at least one a month, I think I will just keep adding to the Hall of Shame. This woman is in her late 80’s and has moderate dementia. She is not able to sleep at night due to bilateral leg pain. Her daughter brought the patient to the Wound Clinic after the patient’s cardiologist suggested that bilateral amputations might be the best option. I sent her for a second opinion with another interventional cardiologist. Photo 1 shows ischemic rubor of both legs.
Photos 2 and 3 are before and after the angioplasty on her left leg. The supply to both legs was improved and as a result, so was her pain. (Thank you to Dr. Sanjaykumar Patel for the angiogram images and for revascularizing her.) While amputation may be necessary in some patients, it would likely have been a death sentence for this lady.
Many patients with critical limb ischemia have ischemic rubor. You can tell when a red leg is due to ischemic rubor because the foot is red when it is dependent (see photo 4) but becomes white with elevation (photo 5). Cellulitis will be hot, but ischemic rubor is not and in fact, the limb may be cold.