Question

A 73 year old man with rest pain and ulceration of the foot undergoes a femoro-distal bypass graft with a PTFE graft. At the end of the procedure there are good distal foot pulses and a warm pink foot. Over the ensuing 60 days the foot becomes progressively cooler and the pulses diminish. What is the most likely underlying explanation for this process?

a. embolus
b. Neo-intimal flap
c. neo- intimal hyperplasia
d. polyarteritis
e. steal syndrome

Answer 1

The gradually worsening condition of the foot with diminished pulses after a femoro-distal bypass graft suggests neo-intimal hyperplasia as the most likely cause, due to the gradual process of narrowing in the graft over time.

Step-by-step explanation:

The most likely underlying explanation for the progressive cooling of the foot and the diminishing pulses in a 73-year-old man who underwent a femoro-distal bypass graft using a PTFE graft is neo-intimal hyperplasia. This condition involves the thickening of the innermost layer of the artery (intima) at the site of the graft. This thickening can lead to a narrowing of the graft, which can restrict blood flow and ultimately result in the symptoms described.

Other options, such as embolus or steal syndrome, may cause sudden changes rather than the gradual worsening over 60 days, as described in the scenario. Neo-intimal flap would typically present with more acute symptoms, and polyarteritis, a type of vasculitis, would not typically present in this way. Therefore, neo-intimal hyperplasia is the most likely cause of the deteriorating conditions of the foot post-surgery.