Case 19: Previous Inadequate Response to Bypass Surgery

This 65 year old woman was referred by her vascular surgeon five weeks after successful bypass surgery. Her previous smoking had left her with diffuse macrovascular disease. Vascular testing now showed her to have a blood pressure ankle/arm index of 0.59 in the right leg and 0.84 in the left. Photoelectricplethysmographic tracings of all her toes were flat. Both feet hurt and she had focal necrotic areas in her right fourth and fifth toes.

Painful feet and Focal Necrosis of two Toes on Presentation

Two Months Later and Healed Toes, Improved Skin and Walking without Difficulty

Both feet did well with outpatient boot therapy. Her ulcers healed and she returned to work.

Comments:A simple case. A woman with an inadequate response to vascular surgery. Was there any other way to help her?.