A 68-year-old man with a 2-year history of chronic venous insufficiency presents to the clinic with a painful, necrotic ulcer on the medial aspect of the left ankle. The ulcer has failed to heal over 6 months despite leg elevation, compression therapy, and appropriate local wound care. His past medical history includes hypertension (managed with lisinopril) and type 2 diabetes mellitus. Vital signs are stable: BP 148/88 mmHg, HR 82 bpm. On examination, the ulcer has a fibrinous base with minimal granulation tissue and is surrounded by hemosiderin staining. Bilateral dorsalis pedis and posterior tibial pulses are palpable and equal. The patient denies claudication or rest pain. Which of the following diagnostic tests would best clarify the contribution of arterial insufficiency to this non-healing ulcer?
- A)Ankle-brachial index with segmental pressure measurementsGABARITO
- B)Venous duplex ultrasound of the bilateral lower extremities
- C)Bacterial culture and wound biopsy for histopathology
- D)Plain radiography and CT imaging of the left ankle
- E)Transcutaneous oxygen pressure measurement (TcPO2) of the lower extremity
Explicação
The ankle-brachial index (ABI) with segmental pressure measurements is the first-line, non-invasive, objective test to quantify arterial perfusion to the lower extremity. An ABI <0.9 indicates significant arterial disease and helps identify patients with mixed... Ver explicação completa e trilha adaptativa →