A patient with diabetes has a nonhealing forefoot ulcer, toe pressure 22 mm Hg and multilevel femoropopliteal and tibial disease. There is no

Question

A patient with diabetes has a nonhealing forefoot ulcer, toe pressure 22 mm Hg and multilevel femoropopliteal and tibial disease. There is no uncontrolled infection, and usable autogenous vein is present. What is the best overarching management strategy?

Accepted Answer

Plan limb-salvage revascularization to restore in-line flow to the ulcer

Answer

Plan wound care and supervised exercise before obtaining anatomic vascular imaging

Answer

Plan primary minor amputation followed by perfusion reassessment and wound care

Answer

Plan endovascular revascularization from the tibial angiogram without conduit assessment

Answer

Plan prostanoid infusion followed by vascular imaging if tissue loss progresses

Chronic limb-threatening ischemia — USMLE Step 3 MCQ

A patient with diabetes has a nonhealing forefoot ulcer, toe pressure 22 mm Hg and multilevel femoropopliteal and tibial disease. There is no uncontrolled infection, and usable autogenous vein is present. What is the best overarching management strategy?