Featured Case:
Dr. Jack Hannallah: 74 Year Old Male

Overview

This case is presented by Dr. Jack Hannallah, who was the managing physician at Modern Vascular in Tucson. In it, he details the case of an Arizona resident suffering from peripheral artery disease. A 74-year-old male with a history of type 2 DM, hypertension, hypercholesteremia, and former tobacco smoker (20 pack year history) presenting for evaluation of bilateral chronic non-healing ulcers on the plantar aspect of his great toes. Present for more than 3 years, the ulcers simply fail to fully heal. The patient is typically very active but ulcers are painful, limiting activities of daily livingg and ability to exercise. Recent radiographs demonstrated osteomyelitis of the left great toe as such focus was first placed on the left side. On physical exam, the patient has palpable pedal pulses the left great toe is red, tender, and swollen with an ulceration on the plantar aspect. Amputation was recommended given the chronicity and non-healing nature. The patient presented for a second opinion as a self-referral. Non-invasive imaging studies demonstrated left-sided TBI of 0.51 with multiphasic flow through the interrogated arteries of the left lower extremity. No evidence of hemodynamically significant stenosis was identified. Despite the lack of overt physical exam and ultrasound findings for arterial insufficiency a diagnostic angiogram was recommended to further evaluate the left lower extremity, given the chronicity and non-healing nature of the ulcer.