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13 — Special Considerations in Evaluating Nonatherosclerotic Arterial Pathology
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AB
C
arterial occlusion may be seen following the deploy- ment of an arterial closure device. These devices are commonly used following femoral arterial catheter- ization to aid with proper closure of the puncture site. The patient presentation seen with this compli- cation is highly variable. Partial thrombosis to com- plete thrombosis with a cold, pulseless leg may be observed.
Scanning Technique
Duplex ultrasound can be directly performed over the puncture site. Depending on the composition of the closure device and where it was placed, it may be difficult to identify. Occasionally, only a small defect may be present in the vessel wall or a slight change in echogenicity noted at the site of the closure device. Figures 13-9A–C were taken at the common femoral artery of a patient who had a cardiac catheterization 3 days prior. A small hematoma was present in the area and weak pop- liteal and femoral pulses were noted on a physical examination. Echogenic material was seen in the proximal common femoral artery consistent with vessel thrombosis. Poor color filling was noted around the thrombus.
Figure 13-9 A: A sagittal ultrasound of a common femoral artery with echogenic material (arrow) present within the lumen consistent with an acute thrombus. B: A thrombus (arrow) in the common femoral artery just proximal to the superficial and deep femoral arteries. C: A color flow imaging demonstrating poor filling around the thrombus with filling of the vessel distal to the thrombus.
POPLITEAL ARTERY ENTRAPMENT SYNDROME
Popliteal artery entrapment is a difficult syndrome to diagnose. Popliteal entrapment occurs when the popliteal artery is compressed by the medial head of the gastrocnemius muscle or adjacent tendons.14 This is the result of a congenital deformity of the muscle or tendon structures. The repeated extrin- sic compression of the popliteal artery produces trauma to the vessel wall, which can lead to an- eurysm formation, thromboembolism, or arterial thrombosis.
The presence of claudication symptoms in a young patient with no risk factors for atherosclerosis is suggestive of popliteal artery entrapment. The on- set of claudication may occur after extensive exercise (such as marathon running), may be chronic with predictable claudication, or may occur with walking but not running. Rarely, symptoms may be acute if the popliteal artery has become occluded. Patients may also complain of numbness or paresthesia of the foot. There is a male to female incidence of 2:1. About two-thirds of patients may have entrapment in the contralateral limb.