Featured Case:
Dr. Pratt 51 Year Old Patient
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This week’s Modern Vascular featured case comes from Dr. Wande Pratt, MD, Board-Certified Vascular & Endovascular Surgeon for Modern Vascular in St. Louis, MO.
Overview
A 51-year-old patient with diabetes, heart disease, and high blood pressure had been experiencing severe pain in his legs while walking for several months. This had made it difficult for him to maintain his job duties as a contractor. When he saw an advertisement about Modern Vascular, he asked his primary care physician who referred him to Modern Vascular for consultation.
At his first visit, he discussed his symptoms with the Nurse Practitioner. He then had an ultrasound, which showed reduced blood flow in his lower extremities. He was informed that he had about 40% circulation in his right leg and 50% in his left leg. On the day of his visit, Dr. Pratt discussed several treatment options, including the option to have a minor procedure called an “angiogram” to improve the blood flow. The patient decided to proceed with the procedure.
On the day of the procedure, the patient met the nursing and procedure staff in the holding area. Dr. Pratt explained that he would perform an angiogram to investigate the blood flow in his right leg. If the blockage was discovered, he would safely improve the blockage through a tiny needle puncture in the artery in the upper thigh. The procedure would be done with minor anesthesia, like that performed for a colonoscopy.
Angiogram revealing occlusion of the femoral artery.
Figure 1
The angiogram of the right leg revealed an occlusion of the femoral artery (i.e. artery in the mid to lower thigh)
Using a special device (Figure 2), Dr. Pratt removed plaque from the femoral artery. He also used a filter device to trap any debris that potentially broke loose and traveled down the leg (Figure 3 and 4).
Figure 2: Special device used to remove plaque from femoral artery.
Figure 3: The filter device.
Figure 4: Filter device used to trap debris that broke loose.
Figure 5
At the end of the procedure, he performed a balloon angioplasty to stretch and widen the narrowed and occluded femoral artery. A completion angiogram demonstrated improved blood flow throughout the femoral artery.
Balloon angioplasty to stretch and widen the occluded femoral artery.
The puncture site was closed and the patient was awakened. The procedure lasted 45 minutes, and he went home about an hour later with a band-aid at the puncture site.
Two weeks later, he returned for a similar procedure on his left leg. At his follow-up visit in the clinic, he reported no pain while walking and stated that he was able to perform his job activities with no limitations.
Before
Angiogram before procedure
The patient was told that their right leg had around 40% circulation and his left leg had around 50% circulation.
After
Angiogram post procedure
A repeat ultrasound study showed significantly improved blood flow with 97% and 94% circulation in his right and left legs.
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