1620_Siah.pdf

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1、Progressive gangrene with Deep Venous Arterialization(DVA)2History of Present Illness85-year old male with complaints of left foot pain and worsening left foot dry gangrene.status post left SFA angioplasty 4/20/23 arthrecotomy with embolic eventsocclusion 5/8/233Past Medical HistoryDiabetes x 20 yea

2、rsAnemiaAtherosclerosis of native arteries of extremity with intermittent claudicationEsophageal refluxHypertensionMixed hyperlipidemiaMuscle weakness(generalized)Nontraumatic ischemic infarction of muscle of lower legChronic Kidney Disease Stage 2StrokeHigh-grade papillary urothelial carcinoma4Phys

3、ical ExamTemp:97.3 F(36.3 C)Pulse:86 Resp:20 BP:145/70 SpO2:94%Weight:60.9 kg(134 lb 4.2 oz)Gen:awake,alert,no acute distress.Abd:soft,nontender,nondistendedExtr:left foot with dry gangrene,no edemaPulse:-RLE:Palpable DP,monophasic doppler PT-LLE:Monophasic PT-BLE:palpable femNeuro:nonfocal.56Assess

4、ment and PlanAssessment:Patient is an 85-year old male with past medical history of DM,CKD,HLD,CVA,BPH,HTN,and PAD evaluated for Left foot dry gangrene.Plan:-Revascularization vs BKADVA-Allow left forefoot dry gangrene to demarcate;plan for future left foot transmetatarsal amputation with planned,st

5、aged xenograft application and split thickness skin graft7Assessment and PlanAssessment:Patient is an 85-year old male with past medical history of DM,CKD,HLD,CVA,BPH,HTN,and PAD evaluated for Left foot dry gangrene.Plan:-Revascularization by Vascular Surgery team-Allow left forefoot dry gangrene to

6、 demarcate;plan for future left foot transmetatarsal amputation with planned,staged xenograft application and split thickness skin graftArteriogram DESERT FOOT AFTER EMBOLIZATIONSuccess of transmetatarsal amputation for limb salvage in pati