This week’s Modern Vascular featured case comes from Dr. Samuel Putnam, Vascular Interventional Radiologist for Modern Vascular in Denver, CO.

Featured Case Overview

58-year-old former smoker with a past medical history of DMII, HTN, HLD, and hx of PE. Referred from a podiatrist for worsening foot pain, poor pedal pulses, and plans to perform a tenotomy on the left second toe. The patient has a history of toe ulcerations and prior partial right 2nd toe amputation for a non-healing ulcer. The patient presented To moderate vascular with complaints of constant numbness in bilateral feet, worsening pain in the toes, and frequent slow-healing blisters of the feet. The symptoms have been progressing over the previous 4 years.

Physical examination demonstrated onychomycosis bilaterally with dystrophic toenails, hyperpigmentation of both feet, small, shallow ulceration of the left second toe, and capillary refill greater than 3 seconds. Evaluation of peripheral pulses demonstrated barely detectable or slightly diminished DP and PT pulses bilaterally. ABIs on were right 1.9, left 1.2, TBI’s on were right 0.99, left 0.85.

Left lower extremity arteriography was performed, which demonstrated wide patency of the femoral-popliteal and tibial arteries. In the foot, the lateral plantar and dorsalis pedis arteries were chronically occluded, and there was no continuous arch. The medial plantar artery was hypertrophied and served as the dominant runoff vessel to the foot. Using endovascular techniques the chronically occluded dorsalis pedis artery was recanalized and the pedal arch was reconstructed with the formation of a pedal loop between the DP and medial plantar arteries. Laser atherectomy of the dorsalis pedis and distal medial plantar arteries was performed, with subsequent angioplasty of these vessels as well as the newly formed pedal loop.

Two weeks after the procedure the patient-related markedly improved symptoms, with increased sensation in the left foot with no pain. He is scheduled for left second toe tenotomy, as well as right leg arteriography for evaluation and probable treatment of his chronic right foot numbness and toe pain.

Pre occluded DP Modern Vascular - Dr. Samuel Putnam

Pre occluded DP

Post shows wide patency of previously occuded DP Modern Vascular - Dr. Samuel Putnam

Post shows wide patency of previously occuded DP

Pre no lat plantar no pedal loop occluded DP Modern Vascular - Dr. Samuel Putnam

Pre no lat plantar no pedal loop occluded DP

Post with reconstructed loop from medial plantar to DP Modern Vascular - Dr. Samuel Putnam

Post with reconstructed loop from medial plantar to DP

Meet the Doctor

Dr. Samuel G Putnam Denver

Dr. Samuel Putnam
Vascular Interventional Radiologist

Dr. Samuel G. Putnam III, M.D., is a dual board-certified Vascular and Interventional Radiologist with 20 years of specialty expertise in peripheral artery disease, fibroid disease, and all facets of interventional oncology. The recipient of academic and military honors, Dr. Putnam has presented nationally, taught radiology residents, authored publications in peer-reviewed journals, and engaged in clinical research.

Learn more about Dr. Samuel Putnam

Dr. Samuel Putnam Modern Vascular Clinic

Modern Vascular of Denver

9441 Huron St.
Thornton, CO 80260

Office Hours: 7am-5pm MST

Phone: (720) 617-7333

Fax: (720) 627-8845

Email: [email protected]