Case Study A

36 Year Old Male
20+ Years Type I Diabetes
Retinopathy and Peripheral Neuropathy
Renal failure, 6 years on Hemodiaysis
Left below knee Amputation
Large right heel Necrotic Ulcer
No runoff vessels for bypass surgery

The first case study deals with a 36 year old male diabetic patient with a non-healing arterial heel ulcer expected to undergo right below knee amputation, since he was not a bypass candidate. The treatment options were amputation or to attempt ulcer healing with this new technology, the ArtAssist®. Saving his leg would mean he could be fitted with a left leg prosthesis allowing a more normal lifestyle for a relatively young man. It was also a consideration that if the heel ulcer could be healed and the leg saved, he would be considered a candidate for a kidney transplant.

Case Study B

68 Year Old Male with Diabetes
4 month history of rest pain and progressive Necrosis
PVR’s were diminished, flat wave form at toe level
No run-off vessels towards the toe

The second case deals with a 68 year old male with diabetes, post Coronary Artery Bypass Graft (CABG), Carotid Endarterectomy (CEA), bilateral femoro-popliteal bypass and bilateral profundaplasty. Patient presented with a 4-month history of rest-pain and progressive necrosis of the right hallux (figure 1). A small lesion was developing on the tip of the second toe. Non-invastive pulse-volume recording (PVR) demonstrated a diminished amplitude of 3 mm at the metatarsal level, with a flat waveform at the toe level.