Peripheral Vascular Disease
A 52-year-old man complained of pain and cramping in his right calf caused by walking two
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blocks. The pain was relieved with cessation of activity. The pain had been increasing in
frequency and intensity. Physical examination findings were essentially normal except for
decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial
pulses were markedly decreased compared with those of his left leg.
Routine laboratory work Within normal limits (WNL)
Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg;
posterior tibial: 88 mm Hg; dorsalis pedis: 88
mm Hg (normal: same as brachial systolic
Arterial plethysmography Decreased amplitude of distal femoral, popliteal,
dorsalis pedis, and posterior tibial pulse waves
Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh
Arterial duplex scan Apparent arterial obstruction in the superficial
With the clinical picture of classic intermittent claudication, the noninvasive Doppler and
plethysmographic arterial vascular study merely documented the presence and location of the
arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography
to document the location of the vascular occlusion. The patient underwent a bypass from the
proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.
Critical Thinking Questions
1. What was the cause of this patient’s pain and cramping? 2. Why was there decreased hair on the patient’s right leg? 3. What would be the strategic physical assessments after surgery to determine the
adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?