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Case Study/Series
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The non-healing wound, a symptom of much more First Author: Trisha Carlson Authors: Dr. Paul Vaughn, Sue Azad RN, Dr. Brian Siegrist, Lisa Bashford RN A 54 y/o former long term smoker with severe hypertension presents to the wound center with a 3 month history of multiple ulcerative lesions on his right leg, debilitating bilateral thigh and calf claudication, nocturnal ischemic rest pain and erectile dysfunction. Prior treatment with antibiotics was unsuccessful. Physical examination revealed an abdominal bruit and non-palpable femoral, popliteal and pedal pulses. Multiple atypical punctuate ulcerations were noted on the right lower extremity. Non-invasive arterial studies confirmed the suspicion of significant aortoiliac inflow disease with severe distal ischemia. Hypercoagulable panel was positive for homocystinemia. Angiography revealed a severe left renal artery stenosis and a total occlusion of the distal abdominal aorta. The patient underwent an aortobifemoral bypass revascularization with an additional bypass to the left renal artery. The homocystinemia was treated with folate replacement therapy. Complete closure of the ulcerations was obtained within eight weeks following surgery. The patient's blood pressure medications were reduced from four pre-op to just one. Erectile dysfunction has improved considerably and the patient is ambulating without claudication and is ecstatic with the improvement of his quality of life! |
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