Today I’d like to share with you an interesting case:
A man in his late 70’s was referred to the vascular lab for a carotid duplex after calling his primary care physician with a complaint of left leg numbness. The physician did not examine the patient but sent him to us for an emergency carotid exam. The patient described intermittent left leg numbness that had been occurring since the evening before.
The carotid duplex was negative for significant plaque formation or stenosis bilaterally. Plaque was present bilaterally without evidence of ulceration or significant irregularity. Normal antegrade flow was demonstrated in the vertebral arteries bilaterally.
During the course of the exam I interrogated the patient in order to get a complete vascular history on him. Our history forms included risk factors and a surgical history, which he filled out. During my questioning he remembered he had a remote left leg stent. After calling his physician we performed a complete arterial study. His ABI was severely reduced and pulse volume recordings were dampened with a saw tooth pattern noted at all levels, suggesting only collateral flow to the leg. An arterial ultrasound was performed. His stent, which was located in the superficial femoral artery, was amazingly patent. His common femoral artery was occluded. Flow in the profunda femoral artery was retrograde and providing collateral flow to the leg. The patient was sent immediately to the Vascular Surgery Department for revascularization.
Interesting case, yes, but the patient may have left the lab following his carotid duplex if I hadn’t pressed him for more history. We’re private investigators on the case – keep searching for clues and maintain a dialogue with your patient.