Presentation
Left lower extremity pain. Revision of lower extremity bypass graft placed in 2018.
Patient Data
Gray scale/color flow doppler
Lower extremity arterial peak systolic velocities found below are in units of cm/s:
Right
External iliac artery: 153.6
Common femoral artery: 110.6
Deep Femoral Artery: 136.7
Proximal superficial femoral artery: occluded
Mid-superficial femoral artery: occluded
Distal superficial femoral artery: 74.5
Popliteal artery: 32.7
Proximal anterior tibial artery: 13
Distal anterior tibial artery: 13
Proximal posterior tibial artery: 32.7
Distal posterior tibial artery: 42.7
Dorsalis pedis artery: 14
Left
External iliac artery: 84.9
Common femoral artery: 79.7
Deep femoral artery: 130.2
Proximal anterior tibial artery: 28.8
Distal anterior tibial artery: 13.4
Dorsalis pedis artery: 14.1
Bypass anastomosis: 48
Left proximal to distal bypass: occluded
Redemonstrated occlusion of the proximal to mid right superficial femoral artery with reconstitution. The right distal superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial arteries, and dorsalis pedis artery demonstrate loss of the normal tri-phasic waveform indicating impaired passage of the pulse wave along the artery, acceleration time qualitatively appears normal but the velocity is reduced and there is spectral broadening indicating turbulent flow.
The left anterior tibial artery demonstrate loss of the normal tri-phasic waveform indicating impaired passage of the pulse wave along the artery, acceleration time qualitatively appears normal but the velocity is reduced and there is spectral broadening indicating turbulent flow.
Case Discussion
This represents a case of a lower extremity (LE) bypass graft occlusion. The patient is an 80-year-old male with a history of LE atherosclerosis. His surgical history included an abdominal aortic aneurysm repair and an interpositional polytetrafluoroethylene bypass graft placement five years ago. At a follow-up clinic visit, the patient reported occasional left LE pain. Arterial imaging for vascular concerns revealed an occluded graft.
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