A 52-year-old male patient with a history of hypertension was treated.
The patient presented with a one-month history of pain in the left popliteal pantor and pituitary gland at 50 meters of gait.
No previous history of intermittent claudication.
Physical examination revealed decreased temperature in the left foot and foot, with absence of popliteal and distal pulse in this limb.
Normal pulses in the right lower extremity.
The non-invasive vascular laboratory confirmed the clinical diagnosis of left femoropopliteal obliteration, so she was hospitalized for angiography.
An angiographic study was performed in the left popliteal artery in a segment of 45 mm long, with a surface area of up to 93%, suggestive of stenosis.
The arterial tree was straight, without endocardial images.
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Attention was paid to appearance of distal and pallid pulse in the affected limb the day after the study.
On the second day after angiography, the patient was scheduled to walk, showing pain in the left pantor.
Examination at this time revealed absence of distal and popliteal pulse.
Non-invasive PVR (recording pulse volume) and PPG showed changes in morphology of the popliteal to distal curves with plane PPG in orthoses.
Magnetic resonance imaging (MRI) was performed with the hypothesis of attaching hematoma syndrome of the popliteal artery, which does not suggest compression of the vessels by any structure, highlighting a hyperintense image in its wall in sequence.
Computed tomography angiography of the lower limbs (IBS AngioTC) showed a cystic image of the endovenous cystic artery in the left popliteal artery at the level of the stenosis.
The patient was operated using a posterior approach. A popliteal vein with a saphenous vein was performed, resecting the popliteal artery in its third, irregularly contoured bridge was observed.
The report of the specimen sent for biopsy concludes “cystic middle degeneration”.
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The patient evolves in good general conditions, with conserved and symmetrical pulses in both IIS, without intermittent claudication and can rapidly reintegrate to his usual activities.
In subsequent controls, the patient is asymptomatic, with normal physical examination and non-invasive vascular study one year after surgery.
