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Amputation

Amputation vs. Embolectomy

09/01/2010

Question:

For a patient with 50yr pack hx of smoking that c/o sudden left toe pain for 5 hours with discoloration, ulcer, no DP/PT pulses are undectectable what would be the initial management? Amputation or Embolectomy

Thank you

Answer:

A thorough examination would be in order. There are other potential reasons for these symptoms, although they seem to point to an arterial blockage. The question becomes, where is it coming from?

For example, a “shower emboli” from a vessel in the leg or abdomen may be responsible and as such may represent a more immediate danger than the toe. Despite non-palpable pulses, there could still be enough circulation to heal a toe ulcer and non-invasive vascular studies would help to determine the extent of circulation.

Finally, an arteriogram would help make a final diagnosis if the non-invasive vascular tests were equivocal and direct the appropriate management.

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Response by:

Jeffrey M Robbins, DPM Jeffrey M Robbins, DPM
Clinical Assistant Professor of Surgery
School of Medicine
Case Western Reserve University