Case+3

__Case #3__

Mr. Caldwell comes to your lab because of claudication of his right buttock and thigh after just a few block of walking. He tells you that he sits down and rests and the pain goes away. He has learned to “just deal with it” he says, because it’s been going on for a while. The doctor has ordered ABI’s both resting and with exercise. You go through your list of history questions and do a brief physical exam including palpating for pulses. You feel grade +3 pulses on the entire left leg. The right leg has weak +1 pulses at the CFA and mid femoral artery. His right popliteal, PTA, and Dorsalis pedis are comparable to the left. His legs look pretty health, other than dry scaly skin. You start the exam with ABI’s. **Calculate ABI’s:**


 * RT Brachial || 120 || ABI || LT Brachial || 150 || ABI ||
 * RT PTA || 90 ||  || LT PTA || 120 ||   ||
 * RT DP || 98 ||  || LT DP || 110 ||   ||

Emily: Rt PTA- 0.6 Rt. DP- 0.65 Lt PTA- 0.8 Lt. DP- 0.73 No, because you know that there is disease in both legs.
 * Will you proceed with the exercise portion of the exam? Why or why not?**

Danielle: I calculated the same numbers as Emily did. I also agree with her that you wouldn't have to do the exercise portion of the exam because you already see disease in both legs. If the ABI's were normal and the patient comes in with claudication then you would want to exercise them to see how the numbers fluctuate with exercise.


 * Why do you think his pulses are comparable at the ankles?**
 * Emily: The disease may be higher up or there are collaterals bringing blood to the ankle. **

Danielle: The entire left leg has a grade of +3 and then upper right leg has a grade of +1 while the lower part of his right leg is comparable to the left, meaning it is at a +3. This could be because the blood is getting down to the right popliteal, PTA, and dorsalis pedis from collaterals that have been made. Also, this could be because there is no disease farther distal, so when the blood does get through the diseased upper portion it returns to normal distally.