Case 37-2003

Presentation of CaseA 79-year-old man was admitted to the hospital because of occlusion at a vascular access site in the right forearm for hemodialysis and worsening intermittent claudication.There was a history of hypertension and coronary artery disease, and the patient had had an acute anterior myocardial infarction six years before this admission, for which he had received tissue plasminogen activator (alteplase); atheroemboli complicated the procedure, and intermittent claudication in both legs and end-stage renal disease developed. After four years of peritoneal dialysis (two years before the current admission), hemodialysis was initiated. Coronary-artery bypass grafting was performed three months . . .