Peripheral arterial occlusive disease is a disease that is always associated with involvement of other vascular beds including Central nervous system, cardiovascular, enteric, renal and other
2. History:-
• 56Y/M, gentleman
• A resident of Bhind, Madhya Pradesh with no formal education and
farmer by occupation.
• A chronic tobacco smoker for last 30 years
• Presented with chief complaints of
- Pain right foot for 20 days
- Blackish discoloration of right 2nd toe for 20 days
3. History of present illness-
• My patient was apparently asymptomatic till 07 Aug 2023, when he
sustained a thorn prick injury to 2nd toe.
• Developed a small blister over 2nd toe which ruptured spontaneously
and progressed into blackish discoloration of 2nd toe.
• It was associated with severe pain in right foot
• Continuous and aching type
• Non radiating
• Pain aggravates on limb elevation or even on slightest of movement
• Pain is even at rest, worst in night interfering with sleep
• Relieves on hanging by side of the bed and he tries to manage by holding foot
• No effect of heat or cold
4. • Associated with paraesthesia and burning sensation in right foot
• H/o intermittent claudication present in ( Claudication distance
around one km after which he use to stop and massage his leg and
walk again.
• No h/o chest pain, transient blackouts , blurred vision, post prandial
abdominal pain
• No h/o impotence
• No h/o buttock pain/thigh pain
• No h/o similar complaints in left lower limb
5. • Patient was initially managed at a civil hospital and later reported to
MH Gwalior where he was evaluated and underwent ray amputation
of right 2nd toe on 24/08/2023.
6. Past history
• No h/o Diabetes Mellitus, Coronary artery disease, CVA
• Recently detected COPD ( Started on ICS+ LABA MDI)
• Was evaluated for intermittent claudication right lower limb in 2019
at MH Bhopal and was diagnosed as a case of right peripheral
vascular disease ( documents not available)
7. Personal history
• Consumes mixed diet
• Chronic bidi smoker for 30 years ( 20 bidis per day). Smoking index=
600
• Occasional alcoholic ( 60 ml alcohol once or twice in a week)
8. Family history
• H/o CVA in father
• H/o CAD in elder brother ( died due to cardiac event)
10. Summary
• 56 years gentleman a chronic bidi smoker for last 30 years with chief
complaints of blackish discoloration of right 2nd toe and rest pain right
foot for 20days with intermittent claudication right calf muscle region
for 5 yrs without involvement of any other vascular bed and with h/o
amputation of right 2nd toe for gangrenous change.
11. On Examination
• General condition- Satisfactory
• Not able to walk
• Pulse- 80/min,
• BP-132/78mmHg
• Temp- Afebrile
• RR-14-16/min
• Pallor+, No Icterus, cyanosis, clubbing, Lnpathy
• Pedal edema +
• Left eye atrophied with no vision since childhood
• Nicotine staining of teeth present
12. Local examination
• Inspection- Right lower limb
• Attitude- partial flexion
• Skin induration present in foot uptil distal 1/3rd,
• Loss of hair present
• Edema present
• Amputation site raw area present with slough and gangrene of 1st and 3rd
toe, line of demarcation 3cm above MTP joint.
• Toe nails brittle
• Leg and thigh normal, no dilated veins
• Left lower limb- Normal
13. Palpation
• Right lower limb-
• Warm to touch ( R>L)
• CFT-10sec
• Sensations reduced
• No foot drop, no weakness at ankle joint
• Crossed leg test- couldn’t be elicited
• Tenderness present
• Amputated site soft tissue necrosis present
14. • Pulses
Pulse Right Left
Femoral Weak ++
Popliteal - ++
ATA - ++
PTA - ++
DPA - +
ABI 0.35 1.03
15. • Auscultation- No bruit/ Abnormal sound heard
• Rest other systemic examination- WNL
16. Summary
• 56 yr gentleman a chronic bidi smoker with chief complaints of rest
pain and blackish discoloration of right foot for 20 days, intermittent
claudication for past 5 yrs and right lower limb pulses non palpable
below femoral with gangrene 3rd toe and amputated 2nd toe with h/o
gangrene.
• Provisional diagnosis- Peripheral arterial occlusive disease right lower
limb.
