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History & Physical

A 77-year-old retired physician presented with B.L.E. claudication, with a history of CAD post-CABG and AVR, prostate cancer, and hypertension. Physical exam revealed diminished left femoral pulse and absent right femoral pulse, with nonpalpable distal pulses. Ankle-brachial indices were critically low at 0.34 on the right and 0.30 on the left, indicating severe peripheral artery disease. Despite initial difficulties in treating the right lesion, successful stenting of the aorta and left iliac resulted in resolution of left claudication and significant improvement in walking ability one month later, although right leg symptoms persisted.

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History & Physical

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  1. History & Physical • 77 yo retired physician with B LE claudication, R>L. • PMH: CAD s/p CABG +AVR 12/03, prostate CA, HTN • Exam: diminished L femoral pulse, no R femoral pulse, nonpalpable distal pulses, no tissue changes • Lab: ABI=0.34 right, 0.30 on L

  2. 50% aortic stenosis High grade proximal RCI stenosis Mid LCI stenosis Occluded R ext iliac Left ext iliac stenosis

  3. Able to pass wire down occluded R ext iliac

  4. 4x2 balloon of proximal R CI to get 6F sheath up and over unsuccessful due to alpha looping of wire

  5. Decided to abort treating R lesion, turned attention to aorta + L iliac system

  6. 10x40 self expanding stent

  7. Post-stent dilatation with 6, 7, and 8mm balloons

  8. 8 x 20mm self expanding stent Post-stent dilation using 6 and 7mm balloons

  9. 6x20mm balloon on external iliac

  10. Follow-Up • Seen back in clinic one month later with resolution of L claudication • Walking significantly improved in terms of L leg, able to walk from parking lot to vascular center without stopping. • Still c/o R leg claudication

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