Presentation
A 1-week history of left foot pain, numbness, and swelling.
Patient Data
CTA Aorto Iliofemoral Run Off
The celiac axis, SMA, and IMA are patent proximally.
Solitary patent arteries bilaterally.
There was no significant aortoiliac stenosis or occlusion.
The right superficial femoral and popliteal arteries are patent without definite evidence of stenosis.
Trifurcation vessels are patent. There is distal reconstitution of the common plantar artery. Questionable distal reconstitution of the dorsal pedal artery.
The left lower extremity demonstrates patency of the superficial femoral artery and profunda femoris arteries. There is occlusion of the distal SFA/proximal popliteal artery. Numerous collaterals are appreciated for supplying the lower leg with distal opacification of the peroneal artery, which gives rise to a common plantar artery and collateral vasculature in the setting of the dorsal pedal artery.
Case Discussion
This represents a case of acute or chronic limb ischemia. The patient presented to the emergency department with left foot pain and swelling. A physical examination showed an asymmetrical left foot when compared to the right. Gangrene of the toes was also observed. The patient reported severe pain after two steps. Arterial ultrasound subsequently showed no acute occlusions, but it was consistent with chronic arterial disease. A CT angiogram confirmed occlusion of the distal superficial femoral artery/proximal popliteal artery.
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