1. Division of Endovascular Interventions
Mount Sinai Hospital
New York
06/20/18

2. History and Physical 64 year old, male
HTN, smoker (1.5 packs per day), CAD s/p PCI, remote CVA with residual paresis
Non-healing ulcer on left 4th toe with rest pain x 4 weeks
BP - 144/76 mmHg
Pulse - 64/min
Left AT and PT have monophasic doppler signal
Dependent rubor, 1+ swelling

3. Labs and work up Hb- 14.5 g/dl Platelets- 193 K INR- 1.1
Creatinine- 1.2
ABI (right), 0.42 (left)
Duplex: low velocity monophasic waveform at right left CFA

4. Strategy
Right CFA access (4 F), left CFA access 7F (25 cm brite tip sheath)
Therapeutic anticoagulation- Heparin
Lesion crossing with wire platform (Confianza) + directional support catheter
Predilatation?
Stent ( Balloon vs. Self expanding, ? Covered)