Images in Clinical Medicine
Peripheral Artery Disease
N Engl J Med 2007; 357:e19November 1, 2007
- Article
A 69-year-old man presented with a 10-day history of discoloration of the left foot and pain in the left foot while at rest. He reported a 1-year history of intermittent claudication in his left leg. His medical history was notable for type 2 diabetes mellitus and hypertension. On examination, his left foot was erythematous, cold to the touch, and pulseless in the dorsalis pedis and posterior tibial arteries while hanging down (Panel A). However, the foot became pale when elevated (Panel B) and became red again while hanging down, which is Buerger's symptom, suggesting the presence of peripheral artery disease. Both feet had some signs of arterial insufficiency, such as loss of hair and thin and dry skin, but there was no pallor or cyanosis. Subsequent angiography showed severe arteriosclerosis involving the right and left external iliac arteries, with stenosis of 67% and 82%, respectively, and total thrombotic occlusion of the left superficial femoral artery. Percutaneous transluminal angioplasty, with stent insertion in both external iliac arteries and in the left superficial femoral artery, restored the distal blood flow. After the procedure, both the redness of the left foot and the ischemic symptoms resolved. Paradoxical redness in patients with peripheral artery disease occurs with very restricted arterial inflow and chronic dilatation of the peripheral vascular bed. The patient was well during the 3-year follow-up period, without recurrent symptoms of arterial insufficiency.
Ho-Cheol Kang, M.D., Ph.D.
Min-Young Chung, M.D., Ph.D.
Chonnam National University, Medical School, Gwangju 501-746, South Korea
drkang@chonnam.ac. kr - Citing Articles (2)
Citing Articles
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Marian M Humphries, Paul F Kenna, Matthew Campbell, Lawrence C S Tam, Anh T H Nguyen, G Jane Farrar, Marina Botto, Anna Sophia Kiang, Peter Humphries. (2012) C1q enhances cone photoreceptor survival in a mouse model of autosomal recessive retinitis pigmentosa. European Journal of Human Genetics 20:1, 64-68
CrossRef2
I. J. Deary, A. J. Gow, A. Pattie, J. M. Starr. (2011) Cohort Profile: The Lothian Birth Cohorts of 1921 and 1936. International Journal of Epidemiology
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