1. LIVE CASE PRESENTATION MOUNT SINAI CARDIAC CATH LAB
NEW YORK
MARCH 8, 2017

2. HISTORY OF PRESENT ILLNESS
Patient is a 75 year old male with a history of hypertension, hyperlipidemia, CAD s/p CABG
History of PVD s/p failed left femoral to popliteal bypass x 2 at outside hospitals
Has had left 3rd and 4th toe amputations
Now presents with left dorsal foot ulcer and dry gangrene as well as ulceration between the 2nd and 5th toes (Rutherford Grade IV; Category 6; Fontaine Stage IV)

4. PAST MEDICAL HISTORY
Hypertension
Hyperlipidemia
PVD s/p failed left femoral to popliteal bypass x 2 in 2013 and 2016
CAD s/p CABG 12/2000
Ischemic Cardiomyopathy s/p ICD
CHF
DVT right lower extremity on anticoagulation

5. MEDICATIONS ALLERGIES ASA Clopidogrel SOCIAL HISTORY Atorvastatin
Carvedilol
Lisinopril
Aldactone
Xarelto
ALLERGIES
NKMA
SOCIAL HISTORY
Smoking: 40 pyh. Quit 10 years ago
Alcohol Use: Occasional
Drug Use: None
FAMILY HISTORY
None
ROS
Negative aside from above

6. Vital- BP 140/84 Pulse 70 Resp 14 Afebrile Neck- No carotid bruits
PHYSICAL EXAMINATION
Vital- BP 140/84 Pulse 70 Resp 14 Afebrile
Neck- No carotid bruits
CV- RRR no murmurs/rubs/gallops
Resp- CTAB
Ext- Ulceration and dry gangrene dorsum of left foot. Ulceration between 2nd and 5th toes. Left DP and PT pulses reveal poor doppler signals.
LABS
HGB 10.1
PLT 129
CR 0.64
INR 1.3

7. ABI: Right ABI Left ABI 0.35.

27. CASE PRESENTATION SUMMARY
75 year old male with PVD, hypertension, hyperlipidemia, CAD who presents with a left foot ulceration and dry gangrene consistent with critical limb ischemia
Left foot ABI of 0.35 with severely blunted waveforms
Peripheral angiogram reveals severe left SFA and infrapopliteal disease
S/P left SFA PTA / Viabahn stent / Zilver stent x 2 and s/p left TPT PTA / Xience stent
Plan: Left infrapopliteal intervention