What Is the Diagnosis? Critical Leg Ischemia

Arun Chakrabarty, MD, Tania J. Phillips, MD, FRCPC

Disclosures

Wounds. 2003;15(5) 

In This Article

Presentation

A 72-year-old Caucasian woman gave a one-year history of redness, itching, and increasing pain of the left foot. She was treated by her previous dermatologist with antibiotics and topical corticosteroid ointments without any signs of improvement. She presented to the authors' clinic for further evaluation. The pain in her left leg had progressed to the point where she was having difficulty sleeping at night and walking more than a city block. The pain diminished with rest and with dependency. Prolonged standing exacerbated the pain. There was no history of deep venous thrombosis, cellulitis, or trauma to the lower extremities.

Her past medical history was significant for status-post myocardial infarction 12 years previously, dilated cardiomyopathy, atrial fibrillation, hypercholesterolemia, chronic obstructive pulmonary disease, and depression. She had a stroke eight years previously with no residual neurologic deficits. Her past surgical history involved a femoral arterial bypass of the right leg about 20 years ago. The patient's medications included enalapril, isosorbide dinitrate, digoxin, coumadin, pravastatin, albuterol inhaler, triamcinolone steroid inhaler, sertraline, and oxycodone with acetaminophen for her left leg pain. She was allergic to aspirin. She has continued to smoke a pack of cigarettes per day for the last 40 years. There was no report of alcohol or drug abuse.

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