Question

How will you evaluate him further?

Hint:

In PAD, a decreasing ABI, especially below 0.5, is associated with critical ischemia, which necessitates urgent intervention to prevent tissue damage.

Answer 1

Step 1: Assessment of Symptoms:
The patient has a feeling of coldness in the foot and disturbed sleep. This suggests the possibility of worsening peripheral artery disease (PAD) or a new vascular issue. A detailed symptom assessment will help guide the evaluation.
Step 2: Re-evaluate Ankle-Brachial Index (ABI):
Given that the patient's ABI has decreased to 0.4, a lower ABI indicates severe arterial occlusion and ischemia. The ABI should be reassessed and compared with previous values to determine any significant worsening.
Step 3: Advanced Imaging:
Since there is significant stenosis in the origin of the profunda femoris artery, advanced imaging techniques such as CT angiography (CTA), Magnetic Resonance Angiography (MRA), or contrast angiography should be used to further evaluate the extent of the stenosis and vascular occlusion.