Apparent Arterio-Venous Anastomosis in Thrombosis of the Femoral Artery

Abstract

Venous filling during the arterial phase on angiography generally implies a shunt via abnormal vascular channels. Such communications are readily understood in arterio-venous malformations and in malignancy but in the patient reported here the primary condition was hypertensive vascular disease with femoral arterial block. Although indubitable femoral vein filling was present during the arterial phase it was not thought that this indicated a by-pass of the capillary bed as in true arterio-venous shunts. An engine driver, aged 63, was discovered to be suffering from diastolic hypertension on routine medical examination. Although symptomless he was treated with Darenthin a sympatholytic agent and his blood pressure was stabilised at 105 mm Hg diastolic, having previously been in the region of 140 mm Hg. A year later he noted mild calf claudication in the left leg on walking a mile to work. Six months after this two ischaemic ulcers developed over the left foot and other signs of vascular insufficiency were noted in the limb. Good left femoral pulsation was present but no popliteal pulsation was detected. Radiological investigation. Direct puncture of the left femoral artery in the groin was performed under general anaesthesia with gas, oxygen and Pethilorfan. Two separate injections of 18 c.c. of 45% Hypaque were required to demonstrate the blood vessels to below knee level. Film changing was by means of a Garrow hand changer thus enabling four films to be taken in six seconds.