Question

A 58-year-old male chronic smoker diabetic and having normal coronaries presents with bilateral calf claudication. Femoral pulses are palpable but distal pulses are absent with bilateral ABI of 0.5 and no rest pain or tissue loss. He has following doubts after reading about peripheral vascular disease on internet and needs a counselling session with the treating vascular surgeon.
Whether he should get operated / intervened or not?

Hint:

For patients with PAD, surgical intervention is considered when symptoms are severe or affect daily life. Medical management should be attempted first for mild cases.

Answer 1

Step 1: Understanding the case.
The patient has a history of smoking, diabetes, and peripheral vascular disease, presenting with bilateral calf claudication. The absence of distal pulses and a low ABI (Ankle-Brachial Index) of 0.5 indicates significant peripheral arterial disease (PAD). While femoral pulses are palpable, the reduced distal pulses suggest compromised blood flow to the lower extremities.

Step 2: Surgical Intervention Consideration.
The decision to intervene surgically depends on the severity of symptoms and the patient's quality of life. In this case, with claudication (pain during walking), the patient may benefit from surgical revascularization if the symptoms are severe or worsening. However, if the symptoms are manageable with medical therapy, surgical intervention may not be necessary. A comprehensive assessment of the patient's functional status and progression of the disease is required.

Step 3: Conclusion.
The patient may be considered for surgical intervention if claudication significantly limits his daily activities. Otherwise, medical management should be considered first.