Male, 32 years old, athlete, with a 3-month history of intermittent claudication.
She suffered necrosis of the first toe of her right foot after these three months.
Physical examination revealed absence of distal and popliteal pulses in the affected limb and dry necrosis of the distal third of the first right finger.
The contralateral limb pulse examination was normal.
A record was made of the pulse volume in the right extremity, being altered from knee to distal.
The ankle-brachial index value was 0.64.
Angiography was performed through the left femoral access, which showed medialization of the right popliteal artery, associated with irregular stenosis of the arterial lumen and post-stenotic dilation of the artery.
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Elective surgery was performed, approaching the posterior popliteal fossa.
During dissection of vascular structures, the popliteal artery was observed displaced medially by the medial head of the gastrocnemius.
Resection of the compromised segment (which was sent for histological study) and interposition of the saphenous vein removed were performed.
In the immediate postoperative period, the patient presented with palpable pulses and posterior tibial pulses.
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The pathology report revealed hyaline atheroma with formation of an aneurysm.
Computed axial tomography (CAT) angiography did not reveal contralateral popliteal artery entrapment.
The patient had a favorable evolution of necrosis.
He required amputation of the first finger at the level of the proximal phalanx 3 months after discharge.
