Dr. Nadal Surprise Arizona Featured Case Cover Image

Featured Case
Dr. Nadal: 89 Year Old Female

This week’s Modern Vascular featured case comes from Dr. Luis L. Nadal, Vascular Interventional Radiologist for Modern Vascular in Surprise, AZ.

Featured Case Overview

The patient is a 89 year old female who presents with risk factors for peripheral vascular disease that include hypertension, hyperlipidemia, prior smoking history and advanced age. She presented to clinic for evaluation of a slow healing wound on her right medial calf, and right heel (Rutherford 4 ). She had undergone a total right knee arthroplasty which subsequently became infected, and then under went revision with Incision and drainage of the site, muscle flap reconstruction, and skin grafting.

The pulse exam revealed normal common femoral artery pulse bilaterally (2+) and non-palpable weakly dopplerable distal dorsalis pedis and posterior tibial arteries bilaterally.

The duplex ultrasound revealed triphasic wave forms of the common femoral arteries bilaterally with velocities in the normal range right 106 (cm/sec), left 87 (cm/sec). The right superficial femoral artery was triphasic proximally with a significant decrease in velocity (41 cm/sec), with no flow visualized in the right mid superficial femoral artery, and flow within the distal right superficial femoral artery with significantly diminished flow ( 15 cm/sec). The right popliteal artery and right anterior tibial arteries demonstrated monophasic wave forms with slightly decreased velocities (pop 50-70 cm/sec and AT 35-40 cm/sec). The right posterior tibial artery did not demonstrate any flow in the proximal and mid segments, with reconstitution of the distal right posterior tibial artery (monophasic 28 cm/sec). The entire left lower extremity demonstrated monophasic wave forms with diminished velocities in the left superficial femoral artery ( 50 cm/sec-20 cm/sec) and left popliteal and left tibial arteries velocities within the noral ranges despite being monophasic.

Toe brachial indices for the right was 0.12 and for the left was 0.38.

Wounds at Presentation

Modern Vascular case study, Dr. Luis Nadal, Modern Vascular in Surprise, Arizona
Angiogram Dr. Nadal
Dr. Nadal Female Angiogram
Combined pedeal and ane grade recannalization
Atherectomy angiogram

After Procedure

Right TBI Now 0.64 from 0.12

Case Outcome and Wound Progression

Dr. Nadal Peripheral artery disease specialist for Modern Vascular in Surprise Arizona

In summary, occluded right proximal/mid superficial femoral artery as well as occluded proximal to mid right posterior tibilal artery. Patent but moderately diseased left superficial femoral artery with patent left tibial run-off. Direct in-line flow established via previously occluded proximal and mid right superficial femoral artery and occluded proximal and mid right posterior tibial artery, completing the pedal loop. Resulting in a TBI of 0.64 which was previously 0.12.

Meet the Doctor

Dr. Nadal: 89 Year Old Female

Dr. Luis L. Nadal
Vascular Interventional Radiologist

Dr. Luis L. Nadal, M.D. is a fellowship-trained Vascular International Radiologist with 17 years of experience. He received his undergraduate degree from the State University of New York at Binghamton, medical degree from the IberoAmerican University, and his residency and fellowship training at Montifore/Jacobi Medical Center of the Albert Einstein College of Medicine in New York.

Learn more about Dr. Luis L. Nadal

Dr. Luis L. Nadal Modern Vascular Clinic