Case 2 A 67-year-old female with obesity, peripheral artery disease, and a history of coronary artery bypass surgery presents with ischemic rest pain (Rutherford category 5) and gangrene of the second toe. Duplex ultrasound and CTA show a flush occlusion of the SFA with poor collateral development and diffuse calcification extending to the P2 segmentWave 2: Module 2: Lower Limb – Week 3 – Case 2

Case 1 56 Year old gentleman presented to your outpatient clinic with rest pain and dry gangrene in tip of his Hallux .Please review his CTA below Q1: What are the benefits and limitations of endovascular treatment  versus open  surgical bypass for this patient in context of the current evidence. Q:2 Can you compare theWave 2: Module 2: Lower Limb – Week 3 – Case 1

Case 2 64years old male heavy smoker and Diabetic. Patient had left femoral endarterectomy and iliac angioplasty done in another hospital 4 weeks ago. He presented to your hospital with temperature 38.9 and WCC 19. His groin wound shows area of erythema and fluid discharge. Q1: How would you approach this case? what are theWave 2: Module 2: Lower Limb – Week 2 – Case 2

Case 1   55 y male patient, smoker, HTN and has pace maker. He works as hospital manager. Presented with CLTI in the form of non healed ulcer on the 2nd to rest pain. He had conflicting advices by multiple surgeons. one is to have enodvascular treatment with SFA stent and second to have fem-pop bypass.Wave 2: Module 2: Lower Limb – Week 2 – Case 1

Case1 •56 years old postman presented to you 6 months ago with right lower limb intermittent claudication at 100 meters, you started him not on any medical treatment, claudication has not improved. and he mentioned it is really affect his work and they might move hm to desk job which he is not keen for.Wave 2: Module 2: Lower Limb – Week 1 – Case 2

Paper 1:   Golledge J, Moxon JV, Rowbotham S, Pinchbeck J, Yip L, Velu R, Quigley F, Jenkins J, Morris DR. Risk of major amputation in patients with intermittent claudication undergoing early revascularization. Br J Surg. 2018 May;105(6):699-708. doi: 10.1002/bjs.10765. Epub 2018 Mar 22. PMID: 29566427. Q1: Please refer to the published abstract of the mentionedWave 2: Module 2: Lower Limb – Week 1 – Case 1

Case 2 Day 2 Q4: Which guidewire is most appropriate for tracking the stent graft into the aneurysm sac? What other wires you need to use in this case ? Q5: You notice that the external Iliac artery on the left side is heavily calcified and stenosed ? How to do you approach this? Q6:Module 1: Foundation Of Vascular Surgery – Week 6 – Case 2 – Day 2

Case 2 Day 1 Case 2 ( please use evidence to support your answer when available) A 82-year-old female with a history of chronic kidney disease and incidental finding of 6 cm abdominal aortic.  Q1: What is the important factors to consider in this lady’s history and clinical examinations.  Q2: What is your approach inModule 1: Foundation Of Vascular Surgery – Week 6 – Case 2 – Day 1

Case 1 Day 2 Q 4: What is your access approach strategy for this patient to facilitate successful CTO crossing Q5: What is your  guidewire escalation strategy and clarify the reasons for your choices ? Q 6:The guidewire is unable to cross the lesion due to heavy calcification. Which type of guidewire should be selectedModule 1: Foundation Of Vascular Surgery – Week 6 – Case 1 – Day 2

Case 1 Day 1 Case No.1 ( please use evidence to support your answer when available) A 65-year-old male with a history of diabetes, hypertension, and smoking presents with lifestyle-limiting claudication in the left lower extremity. His DUS reveals a chronic total occlusion (CTO) of the superficial femoral artery (SFA).  Q 1:What is the importantModule 1: Foundation Of Vascular Surgery – Week 6 – Case 1 – Day 1