Question

Clinical Course:

The patient was hospitalized and both wound and blood cultures were started. Mrs. B. was treated with broad-spectrum antibiotics while waiting for culture reports. The wound was packed with saline-soaked Kerlix gauze to facilitate debridement of necrotic tissue. The patient was provided continuous insulin by IV with frequent monitoring of blood glucose concentrations. Serum glucose levels were maintained at 80–100 mg/dL. An electrocardiogram was normal. Wound and blood culture reports were eventually completed. The wound was contaminated with gram-positive bacteria, but the blood culture was negative.

Magnetic resonance angiography of the right lower extremity was subsequently performed and a right tibial artery obstruction was identified. The section of diseased vessel was short (3.0 cm), but there was 70% narrowing of the artery. The angiogram also showed some degree of collateral circulation around the obstructing lesion. The patient underwent successful percutaneous angioplasty of the diseased vessel and placement of a stent to restore blood flow. The foot wound showed significant signs of healing after several days of bedrest and continued antibiotic therapy. A decision to perform an amputation of the right foot was averted.

Case Study Questions:

1. Based on the information provided in the patient’s clinical workup, what type of medication is ultimately necessary?

2. What is the pathophysiology of peripheral arterial disease?  

3. Discuss surgery for PAD.  

Answer 1

Answer: On the basis of the information, the patient is not having proper blood circulation hence it is important that the drug cilostazol should be given. This drug will increases the blood flow all over the limbs by widening vessel and making blood thinner.

The pathophysiology of peripheral arterial disease includes as the PAD occurs due to the blockage in the arteries that supplies blood to the limbs specially at the lower limbs. This causes low flow of blood to the lower limbs which results in loss of limb.

The surgery for PAD includes:

• cryo-balloon angioplasty
• Bypass grafting
• Cryoplasty.

These surgery can reduce the risk of the disease as by removing the blockage of the arteries.