What is the Diagnosis? Critical Leg Ischemia

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Author(s): 
Arun Chakrabarty, MD; Tania J. Phillips, MD, FRCPC

Department Editor: Tania J. Phillips, MD, FRCPC

Overall Learning Objective: The physician or podiatrist participant will develop a rational approach to the evaluation and treatment of a variety of uncommon wounds and will have an increased awareness of the differential diagnosis of cutaneous wounds and the systemic diseases associated with these wounds.

Submissions: To submit a case for consideration in Diagnostic Dilemmas, e-mail or write to: Executive Editor, WOUNDS, 83 General Warren Blvd., Suite 100, Malvern, PA 19355, eklumpp@hmpcommunications.com

Completion Time: The estimated time to completion for this
activity is 1 hour.

Target Audience: This CME/CPME activity is intended for dermatologists, surgeons, podiatrists, internists, and other physicians who treat wounds.

At the conclusion of this activity, the participant should be able to:
1. Discuss the general risk factors of peripheral vascular disease
2. Explain the urgency of critical leg ischemia
3. Describe FDA-approved medications for peripheral vascular
disease
4. Describe the nonpharmacologic treatment role of peripheral
vascular disease
5. Discuss the current pathophysiology of peripheral vascular
disease
6. Describe the clinical signs of peripheral arterial disease.

Disclosure: All faculty participating in Continuing Medical Education programs sponsored by HMP Communications, LLC, are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation. Drs. Chakrabarty and Phillips disclose that they have no conflicts of interest relevant to the content of this article.

Accreditation: HMP Communications, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. HMP Communications, LLC, is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine.

Designation: HMP Communications, LLC designates this continuing medical education activity for a maximum of 1 credit hour in category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. HMP Communications designates this continuing medical activity for .1 CEUs available to participating podiatrists.

Method of Participation: Read the article, take, submit, and pass post-test by March 10, 2004.

This activity has been planned and produced in accordance with the ACCME Essential Areas and Policies.

Release date: 5/10/03

Expiration date: 5/10/04

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.

References: 

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