Occult popliteal artery stenosis masquerading as atheroemboli in a patient with previous knee replacement (original) (raw)
Related papers
Non-healing ulcer of right foot due to Monckeberg's arteriosclerosis
BMJ case reports, 2015
A 55-year-old woman, a known hypertensive on treatment, was admitted with right lower limb claudication on walking up to 100 m; there was pain on rest. She had an ulcer in the third interdigital space of the right foot for 3 months, which had not healed in spite of regular wound dressing. The patient denied history of trauma. On physical examination, her right lower limb was cold with absence of popliteal and distal pulses, and had a marked pallor at limb elevation. There was presence of an ulcer in the third interdigital space. The left lower limb was normal, with normal femoral pulse and absence of popliteal and distal pulses.
Peripheral Arterial Disease in the Leg
Journal of Evolution of Medical and Dental Sciences, 2014
Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. While PAD is a major risk factor for lowerextremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. Atherosclerosis accounts for more than 90% of cases of PAD, and uncommon vascular syndromes account for the remaining 10%. The femoral and popliteal arteries are affected in 80% to 90% of symptomatic PAD patients, the tibial and peroneal arteries in 40% to 50%, and the aortoiliac arteries in 30%.Although 65-75% of patients with PAD are asymptomatic, the classic presenting symptom is usually described as muscle cramps, fatigue or pain in the lower legs induced by exercise and rapidly relieved by rest; often the symptom location indicates the level of arterial involvement. RISK FACTORS: Diabetes and smoking are the strongest risk factors for PAD. Other well-known risk factors are advanced age, hypertension, and hyperlipidemia. DIAGNOSIS: PAD can be easily and accurately diagnosed by calculating the ankle-brachial index (ABI).The ABI is defined as the ratio of the systolic blood pressure in the ankle divided by the systolic blood pressure at the arm. The tools required to perform the ABI measurement include a hand-held 5-10 MHz Doppler probe and a blood pressure cuff. MANAGEMENT: Most patients' symptoms improve with optimal medical treatment and invasive intervention is often not required. Smoking cessation and exercise are considered the two most important treatments for PAD. CONCLUSION: Symptomatic PAD often impairs a patient's quality of life and untreated disease can lead to limb loss. Aggressive management of atherosclerotic risk factors, a structured exercise program, use of antiplatelet agents and when indicated percutaneous or surgical revascularizations are the keys for successful management.
Complication inhabituelle d’une embolectomie fémorale « Aveugle »
Annales de Chirurgie Vasculaire, 2010
Les faux an evrysmes iatrog enes apr es embolectomie f emorale sont rares et ont et e d ecrits dans les art eres poplit ee, tibiale post erieure, et p eroni ere. Nous pr esentons un cas peu commun d'un tel faux an evrysme provenant d'une collat erale g enicul ee sup erieure m ediale qui naissait de l'art ere poplit ee proximale a angle aigu. Il est probable que le cath eter d'embolectomie ait accidentellement p en etr e dans cette branche, qui s'est rompue quand le ballon a et e gonfl e. L'embolisation transluminale par spires a eu comme cons equence la thrombose r eussie du faux an evrysme.
Patterns of Arteriosclerotic Lesions of the Lower Extremity
Annals of the New York Academy of Sciences, 1968
INTRODUCTION This study aimed to determine whether ethnic differences show different patterns of arterial disease in the lower limb. METHODS A prospective analysis of 100 consecutive patients with 160 lower limb arteriograms was performed looking at the pattern of disease with relation to ethnicity in Trinidad and Tobago. RESULTS There were 53 male and 47 female patients with an age range of 43-90 years (mean: 66 years). Of the 100 patients, 45 were of East Indian descent, 36 of Afro-Caribbean descent, 14 of mixed descent and 5 had other backgrounds. There were 32 smokers and 69 diabetics. The most commonly affected artery in East Indians was the anterior tibial artery (ATA, 70%) followed by the peroneal artery (60%), superficial femoral artery (SFA, 60%), posterior tibial artery (PTA, 57%) and tibioperoneal trunk (TPT, 39%). In Afro-Caribbeans, the most commonly affected artery was the ATA (79%) followed by the PTA (74%), peroneal artery (66%) and TPT (55%). The mixed group showed the PTA (85%) to be most diseased followed by the peroneal artery (75%), ATA (70%), SFA (70%), dorsalis pedis artery (DPA, 60%) and TPT (50%). Overall, the most diseased vessel in all groups was the ATA (73%) followed by the PTA (66%), peroneal artery (64%), SFA (59%), TPT (46%), DPA (38%), popliteal artery (31%) and medial plantar artery (MPA, 29%), with the proximal vessels not being affected severely. CONCLUSIONS Ethnic divisions were only statistically significant (p<0.05) with East Indians showing worse disease in the profunda femoris artery and Afro-Caribbeans showing worse disease in the PTA, DPA and MPA. This suggests that environmental factors may play a significant role in the disease process including smoking and dietary factors rather than purely genetics.
Journal of Atherosclerosis and Thrombosis, 2023
Aims: Though the number of patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI) is increasing, few histopathological studies of PAD, particularly that involving below-the-knee arteries, has been reported. We analyzed the pathology of anterior tibial artery (ATA) and posterior tibial artery (PTA) specimens obtained from patients who underwent lower extremity amputation due to CLI Methods: Dissected ATAs and PTAs were subjected to ex-vivo soft X-ray radiography, followed by pathological examination using 860 histological sections. This protocol was approved by the Ethics Review Board of Nihon University Itabashi Hospital (RK-190910-01) and Kyorin University Hospital (R02-179). Results: The calcified area distribution was significantly larger in PTAs than in ATAs on soft X-ray radiographic images (ATAs, 48.3% 19.2 versus PTAs, 61.6% 23.9; p 0.001). Eccentric plaque with necrotic core and macrophage infiltration were more prominent in ATAs than in PTAs (eccentric plaque: ATAs, 63.7% versus PTAs, 49.1%; p 0.0001, macrophage: ATAs, 0.29% [0.095-1.1%] versus PTAs, 0.12% [0.029-0.36%]; p 0.001), histopathologically. Thromboembolic lesions were more frequently identified in PTAs than in ATAs (ATAs, 11.1% versus PTAs 15.8%; p 0.05). Moreover, post-balloon injury pathology differed between ATAs and PTAs. Conclusions: Histological features differed strikingly between ATAs and PTAs obtained from CLI patients. Clarifying the pathological features of CLI would contribute to establishing therapeutic strategies for PAD, particularly disease involving below-the knee-arteries.
Taking PET for a Walk -- an Unusual Cause of Bilateral Leg Claudication
The Journal of Rheumatology, 2010
Large-vessel giant cell arteritis (LV-GCA) is a rare condition that is increasingly recognized with the advent of imaging techniques such as positron emission tomography (PET). However, the utility of PET in extracranial GCA is poorly defined and rarely reported, especially in lower-limb LV-GCA. We describe a case of GCA affecting the lower limbs in which PET, corroborated with computed tomography angiogram (CTA) and duplex ultrasound, was used to accurately assess and monitor the activity of this rare arteritis. A 59-year-old woman with minimal atherosclerotic risk factors presented with a 3-month history of progressive bilateral leg claudication. She initially noticed tightness in her right calf after walking 100 meters on level ground. The discomfort was proportional to exertion, and would promptly resolve with rest. There was similar, although less intense, discomfort in her left calf, and associated bilateral numbness in her middle 3 toes. Three months previously she had unlimited exercise tolerance on level ground. One month after the onset of claudication, her symptoms progressed to include bilateral thigh discomfort on exertion. There was no scalp tenderness, visual disturbance, jaw or tongue claudication, or polymyalgic or joint symptoms. She had lost 2.5 kilograms (4% total body weight) over 3 months. Her medical history was unremarkable. Her atherosclerotic risk factors included a brief 2.5 pack-year smoking history and a family history of lower-limb arterial disease (sister requiring femoropopliteal bypass at age 49 years) and old-age ischemic heart disease. On examination, the left popliteal artery and bilateral pedal pulses were absent. The right popliteal pulse was weakly palpable, and femoral pulses were present. There were no femoral, renal, or lower abdominal bruits. Temporal arteries were nontender, with normal pulses. There were no carotid, subclavian, or axillary artery bruits. Lower-limb neurological examination was normal. Initial blood tests showed a mildly elevated C-reactive protein at 9.2 mg/l (normal 0-5 mg/l), with normal erythrocyte sedimentation rate and full blood count. Hepatitis B and C serology, cryoglobulins, autoimmune and vasculitic markers, thrombophilia screen (protein C & S, homocysteine, Factor V Leiden, prothrombin gene G20210A polymorphism), and antiphospholipid antibodies were negative. The lipid profile, random blood glucose, creatine kinase, creatinine clearance, and urinalysis were also unremarkable. Initial duplex ultrasound examination of lower-limb arteries revealed significant stenotic femorotibial disease bilaterally, suspicious for vasculitis. There was diffuse and irregular circumferential intima-media thickening of the arterial wall extending from the origins of both superficial femoral arteries to the popliteal and calf arteries, with complete occlusion of the right tibioperoneal trunk. Specifically, along the length of the left superficial femoral artery, there were 1 cm-length focal stenoses of 50%-75% diameter reduction at 12, 15, and 18 cm below the groin crease, and associated periadventicial, hypoechogenic lucencies. The right superficial femoral artery had marked, irregularly thickened walls from its origin along its full length. Minor luminal irregularities were also present. Two focal short segments of 50% and 75% diameter stenoses were present at 5 and 13 cm below the right groin crease. No calcifications were visualized in the lower-limb arterial tree. CTA of the aorta and lower limbs showed smooth, circumferential wall thickening highly suggestive of arteritis, involving the abdominal aorta, bilateral common femoral, superficial femoral, profunda femoris arteries, and their thigh and calf branches. Whole-body PET showed an increased tracer uptake pattern suggestive of large-vessel vasculitis, with distribution corresponding to the duplex and CTA findings (Figure 1). Duplex ultrasound of the temporal arteries showed occlusion of the distal left temporal artery with echolucent intimamedia thickening suspicious of arteritis. GCA was confirmed on left tem