Silent coronary ischemia in a patient with critical limb ischemia: Diagnosis and management using coronary CT-derived fractional flow reserve (FFR_CT)

Patients with symptomatic peripheral arterial disease are at high risk of premature cardiovascular death as a result of coronary artery disease. Coronary ischemia may be silent and unsuspected due to lack of chest pain symptoms, and clinical guidelines recommend preoperative cardiac testing only if the results have the potential to alter patient management. A new noninvasive diagnostic test, coronary CT-derived fractional flow reserve (FFR_CT), can reliably identify ischemia-producing coronary stenosis and has the potential to alter patient management. This case example outlines the successful management of a patient with critical limb ischemia and femoral pseudoaneurysm who was found to have severe silent coronary ischemia by pre-operative coronary computed tomography angiogram and FFR_CT assessment.