arterial case studies

A 69-year-old man presents to the emergency department with a 1-day history of a cold, purple left foot. He has a history of a left common femoral artery-popliteal bypass graft. Gray-scale imaging demonstrates low-level echoes within the lumen of the graft. No detectable color or spectral Doppler flow is noted. The native popliteal artery distal to the graft has a monophasic spectral Doppler waveform. What is the most likely diagnosis?

occluded arterial bypass graft

A 68-year-old man sees his primary care physician regarding right leg pain during exercise. He mentions he has difficulty walking a single block without the right calf cramping to the point where he has to stop and rest. Gray-scale imaging demonstrates heavily shad owing plaque throughout the right superficial femoral artery. Color Doppler demonstrates flow with luminal irregularities throughout the entire femoral artery except in the midportion where no flow is seen. Spectral Doppler confirms this finding, demonstrating monophasic flow with a good upstroke in the proximal femoral artery, no flow in the mid to distal femoral artery, and tardus parvus flow in the proximal popliteal artery. What is the most likely diagnosis?

occluded superficial femoral artery

During his annual physical, a 79-year-old man is noted to have a palpable, nontender, slightly pulsatile mass in the right popli teal fossa. No defect is noted on the left side. He is promptly sent for a sonogram. Gray-scale imaging demonstrates a focal, dilated segment of the right popliteal artery that measures 3.1 cm in all dimensions. Visible echoes can also be seen within a portion of the lumen. Color Doppler shows normal flow in the nondilated segment and a yin-yang appearance in the dilated portion. Spectral Doppler is essentially normal. What is the most likely diagnosis?

popliteal aneurysm with mural thrombus

After a crushing injury to the left calf during a car accident, a 23-year-old woman complains of swelling and severe calf pain, specifically when the area is palpated or she moves her foot. Her pain has not been relieved by medication, and she states she is starting to lose sensation in her foot. Physical examination reveals a swollen calf with shiny skin and an absent pedal pulse. Gray scale imaging does not reveal any intimal damage; however, spectral Doppler waveforms are high resistive in the popliteal artery and gradually diminish as samples are taken distally in the peroneal and posterior tibial arteries. What is the most likely diagnosis?

compartment syndrome

After a cardiac catheterization, a 72-year-old woman complains of pain in her groin. On physical examination, the physician notes a bruit in the area of arterial access. Spectral Doppler reveals high velocity, low-resistance waveforms in the common femoral artery proximal to the site of the catheterization and reduced flow dis tal to the site. The common femoral vein is also noted to have increased pulsatile flow above the puncture site. A thrill can be palpated on the skin, and flash artifact is evident on color Doppler. What is the most likely diagnosis?

arteriovenous fistula