Department of Surgery

King Fahd University Hospital

Morning report

Date: /12/2018
Dr. Ayman Saad
Dr.Amr AlBayomi
Omar AlOthman
 History
 33 Y/O Saudi male , smoker
 Past surgical History : Right Above knee amputation due to
delayed acute Limb ischemia with failure of limb salvage after
a trial of pharmacological and mechanical thrombectomy 2016
 Presented ( on December 2018) with history of Left Lower
Limb Pain x 1 week duration
 insidious onset of pain , attacks become more converged
over time
 On/off , intermittent became constant in the last 2-3 days
 Mild to moderate in severity
 Relieved partially by analgesia
 History
 No other complaints or associated symptoms
 Sought medical advise (periphery) , underwent investigations
including duplex U/S showed significant findings , provided
only dual antiplatelet , conservative management
 Never been investigated for the underlying probable cause of
previous incidence
 Examination
 Well built , Conscious, oriented and alert.
 Not pale or jaundiced, in pain

Temp Pulse BP RR Spo2

37 79 146/77 20 98%
 Pericardium : S1 + S2 + 0.
 Chest : EAEB , no added sounds.
 Abdomen : Soft , lax , no tenderness.
 Local Examination :
 Cold left lower limb
 Palpable femoral artery
 Impalpable or even audible pulses including (popliteal ,
Dorsalis pedis and posterior tibial arteries )
 Pedal Venous audible signals ( hand held Doppler )
 No tissue loss ( ulcer or gangrene )
 Numbness till lower third of the leg
 Mild motor weakness 4/5
 Investigations
WBC Hgb Plt
8.8 14.0 280

T Bili D Bili ALK GOT GPT GGTP LDH Albumin

1.3 0.28 105 25 21 35 190 3.9

BUN Cr Na K Cl
134 4.8 94

aPTT PT
31.9 12.9
Imaging ( CT Angio )
 Profunda femori
artery

collaterals

PTA
Diagnosis
 Delayed acute on top of chronic left lower limb ischemia
 Hospital course
 Emergency admission and OR
 Left Lower limb ( Femoral ) thrombembelectomy by femoral
exploration , sequential Fogarty catheter and completion
angiography
 Post operatively
 Symptoms improved substantially
 Monophasic audible signals over pedal pulses (hand held Doppler)
 Work-up and investigations with regard to concerned services for
underlying cause
 Cardiology : Echo was done twice : EF 40-45 % , evidence of non
compaction cardiomyopathy , No LV thrombus , advised to continue on
anticoagulation
 Rheumatology : No evidence of Connective tissue disease
 Hematology : requested for multiple laboratory investigations and
signed off
 Oral anticoagulation ( Warfarin ) started last Thursday
 For possible discharge after reaching stable targeted INR
Thank you ..