Case 58: Right Leg Cured in spite of Disease and Multiple Vascular Procedures and Left Leg Cured along the Way

At age 82, this nondiabetic lady presented at a nearby community hospital with a three week history of pain and numbness in the right foot and big toe. She had noted one-block claudication for two months and nocturnal rest pain for two weeks. In spite of the Trental prescribed by her family doctor, her symptoms had worsened. She had a femoral-popliteal bypass and a thrombectomy of her posterior tibial performed January 3rd, 1986. The bypass failed the same day and she was taken back to the operating room for thrombectomies of the bypass, the superficial femoral and the posterior tibial arteries. After the procedures, streptokinase was infused into t he leg but was followed by hemorrhage taking her back again to the operating room for exploration and hemostasis. The leg survived the procedures and she was discharged for observation. February 24th, 1986 she was readmitted for an arteriogram. The right superficial femoral and the femoral-popliteal bypass were occluded. She had advanced trifurcation disease with extremely impaired runoff. There was no major vessel reconstitution in the right leg. Her vascular surgeon advised leg amputation. She was discharged to a nursing home with Tylox for pain relief.

A friend referred her for boot treatment.

She presented April 7th with a black eschar on the heel.

Her toes were raw, red and painful. A small ulcer at the end of the first toenail is not well seen in the photo.

She had a querulous nature but persisted with her treatments. Her pain was slowly relieved and she became ambulatory and returned home. On the 2nd of December, 1986 she complained of pain in her left big toe. Treatment on the left leg was begun.

The left or untreated leg had become the symptomatic leg. Note the difference in the color of the big toes.

The right heel was healed. Only a small pink spot marked the area of her previous ulcer.

Comments: Both legs served her well until she died five year later. It is a shame we were not able to treat her before her multiple vascular procedures. It is likely we might have spared her considerable costs, pain and sick time. >.