Artery Duplex Research Articles

ASSOCIATION BETWEEN ERECTILE DYSFUNCTION AND SEVERITY OF CORONARY ARTERY DISEASE

Background: Erectile dysfunction (ED) is the most common sexual problem in men and defined as inability to attain or maintain a penile erection sufficient for successful vaginal intercourse. Erectile dysfunction is considered a primarily vascular disease in the majority of the cases. Numerous risk factors that contribute to the development and onset of ED are principal for the development of coronary artery disease (CAD). Objective: Documentation of the relation between erectile dysfunction and severity of coronary artery disease in patients presented with acute coronary syndrome focusing on the relation between onset of erectile dysfunction and onset of acute coronary ischemia. Patients and methods: This study included Egyptian patients admitted with acute coronary syndrome (ACS) with history of erectile dysfunction (ED), and underwent coronary angiography. They were subdivided into 3 groups: Group1 (control group G1, n= 30) which have a normal coronary angiography or non-atherosclerotic coronary artery disease, group 2 (G2, n= 36) which have a single coronary artery disease, group 3 (G3, n= 34) which have more than one coronary artery disease. Comparative study was done between three groups according to risk factors, comorbidities and severity of atherosclerotic coronary artery lesions according Gensini score, degree of erectile dysfunction which was assessed by international index of erectile function (IIEF) and penile artery duplex. Results: The total number of patients admitted with acute coronary syndrome (ACS) and diagnosed as erectile dysfunction patients according international index of erectile function (IIEF) was 36. The total number was 6 (20.0%) in the control group, 10 (27.8%) in the second group, 20 (58.8%) in the third group with a significant difference between groups. Comparison between results of penile artery duplex in our study groups was classified according to response to papaverine injection into either no erection, tumescence and rigidity not sufficient for intercourse, tumescence and rigidity sufficient for intercourse or full erection. There was no significant difference between groups. Conclusion: The recognition of ED was a warning sign of silent vascular disease. It has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.

Autogenous Femoral Vein for Secondary Repair of Subclavian Arteries: A Salvage Solution for Complex Clinical Scenarios

Endovascular stents and prosthetic grafts are commonplace techniques for correction of subclavian artery (SCA) lesions. However, when initial surgical repair of the SCA becomes complicated by subsequent infection or thrombosis of the repair site, stents and prosthetic grafts are no longer suitable for secondary repair because of the risk of recurrent failure and limited longevity. Autogenous tissue is more resistant to infection and has improved long-term patency and thus may be a better option for secondary reconstruction in these complex clinical scenarios. The most commonly used autogenous conduit for SCA reconstruction is the great saphenous vein; however, the significant size mismatch makes this unsuitable in many circumstances. The autogenous femoral vein is a promising alternative conduit for SCA repair. Here, we present three successful cases of its use as a salvage technique after iatrogenic complications of prior surgical repair. From 2015 to 2019, three patients underwent harvest of the femoral vein for use in SCA repair, with two carotid-axillary bypasses and one carotid-subclavian bypass. Indications included a mycotic pseudoaneurysm secondary to an infected SCA stent, an SCA avulsion secondary to an infected carotid-subclavian bypass graft, and an occluded SCA stent in a young patient. Postoperative graft patency was monitored through clinical resolution of symptoms and maintenance of perfusion, intact pulses, and arterial duplex ultrasound or computed tomography scan. All of these patients had a good outcome after their procedures. Each had intact radial pulses immediately postoperatively and maintained normal perfusion to the upper extremity for the duration of follow-up, with bypass patency confirmed by computed tomography scan (Fig 1) or arterial duplex ultrasound (Fig 2). The SCA repair also allowed salvage of the upper extremity and symptomatic relief in all patients. None of the patients developed deep venous thrombosis in the donor extremity, and neither of the infected patients developed recurrent infection of the repair site. The success of these cases demonstrates that the autogenous femoral vein is an effective and safe option for SCA reconstruction. It is particularly useful for secondary salvage when prior surgical repair by standard techniques is complicated by infection or thrombosis and when target vessel size precludes the use of the great saphenous vein. This is an excellent choice of conduit that vascular surgeons should consider for use in complex SCA repairs.Fig 2Postoperative arterial Duplex scan of carotid-subclavian bypass graft via femoral vein.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Arterial Duplex Utilization Prior to First-Time Infrainguinal Peripheral Vascular Intervention Among Medicare Beneficiaries

There is some concern that the use of office-based lower extremity duplex ultrasonography before index peripheral vascular intervention (PVI) is being overused, particularly in patients who have already undergone lower extremity computed tomography angiography (CTA). We aimed to identify patient- and physician-level characteristics associated with the use of lower extremity arterial duplex in addition to CTA before first-time endovascular intervention for infrainguinal peripheral vascular disease.

Trends in Postoperative Carotid Duplex Surveillance Ultrasound After Carotid Artery Stenting

The aim of this study was to investigate trends in surveillance carotid artery duplex ultrasound examination after carotid artery stenting (CAS) and to investigate the association between postoperative duplex ultrasound restenosis and long-term ipsilateral stroke or transient ischemic attack (TIA).

Carotid Duplex Velocity Alterations Among Left Ventricular Assist Device Patients: Need for a Shift in Criteria?

Carotid duplex interpretation are based on velocity cutoffs and internal carotid artery/common carotid artery (ICA/CCA) ratios. Patients undergoing left ventricular assist device (LVAD) implantation pose a challenge in the standard interpretive criteria. The continuous flow produced by an LVAD alters normal pulsatile physiologic blood flow, lowering systolic flow and increasing diastolic flow. Therefore, we hypothesized that the presence of an LVAD alters the velocities observed on carotid artery duplex ultrasound examination, rendering traditional criteria difficult to interpret.

Arterial Duplex and Palmar Acceleration Time in an Upper Extremity Trauma Case

Subclavian and axillary arterial injuries are uncommon and in the setting of scapulothoracic dissociation present difficulties in diagnosis, assessment, and reconstruction. We present a case of subclavian artery disruption in such a setting, in which palmar duplex identified the need for reperfusion and provided assessment of an extra-anatomic bypass. Palmar arterial duplex may provide a useful tool in select cases of upper extremity arterial trauma.

Calciphylaxis and Mönckberg’s Arteriosclerosis in a Diabetic Patient

Diffuse arterial calcification is characteristic of peripheral arterial disease (PAD), particularly in diabetic patients. In diabetic patients, the rates of PAD and the more advanced forms of vascular disease such as critical limb ischemia are higher, and vascular intervention is known to be more difficult and less effective. For 1 in 6 patients, below-knee amputations can result from microvascular disease without traditional PAD. Microvascular disease occurs in vessels with a diameter around 100 µm and is most commonly present in diabetic patients. Calciphylaxis is a life-threatening complex disorder that presents with painful ischemic skin lesions caused by occlusion of blood vessels in subcutaneous fat and dermis. Mönckberg’s arteriosclerosis results in extensive calcium deposits in the tunica media without obstruction into the lumen. This case highlights a young diabetic patient with rapidly progressing acute onset ulcers of the bilateral lower extremities status post beginning peritoneal dialysis. The patient underwent upper and lower arterial noninvasive studies, angiogram, computerized tomography angiography, and punch biopsy. The arterial duplex examinations were normal with the exception of noncompressible calcified vessels. Microvascular disease was correlated with angiogram. Computed tomography angiogram findings were conclusive for calciphylaxis and Mönckberg’s arteriosclerosis. Punch biopsy was performed to confirm calciphylaxis and patient was started on the appropriate treatment regimen. Unfortunately, limb salvage was not possible and amputations were ultimately performed. There are other vascular pathologies that are not associated with traditional large artery atherosclerosis, such as calciphylaxis and Mönckberg’s arteriosclerosis. Even with seemingly normal arterial testing, the prognosis can be catastrophic. Although rare, these additional disease processes should be considered in dialysis patients with acute ulcerations.

Ruptured Popliteal Artery Aneurysm Complicated with Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

We herein report a rare case of the ruptured popliteal artery aneurysm in an 89-year-old man, whose recovery after surgical treatment was complicated with acute respiratory distress syndrome secondary to confirmed infection with SARS-CoV-2. Presenting symptoms, patient's comorbidities, and postoperative course complicated with cardiac and respiratory failure leading to adverse outcome are discussed in this case report.

Outcome benefit of arterial duplex stent imaging after superficial femoral artery stent implantation

ObjectiveIn-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation, whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up. MethodsWe performed a retrospective analysis of all patients undergoing SFA stent implantation for occlusive disease at a tertiary care referral center between 2009 and 2016. The patients were divided into those with ADSI and those with ABI follow-up only. Life-table analysis comparing stent patency, major adverse limb events (MALEs), limb salvage, and mortality between groups was performed. ResultsThere were 248 patients with SFA stent implantation included, 160 in the ADSI group and 88 in the ABI group. Groups were homogeneous in clinical indications of claudication and critical limb-threatening ischemia (for ADSI, 39% and 61%; for ABI, 38% and 62%; P = .982) and TransAtlantic Inter-Society Consensus class A, B, C, and D lesions (for ADSI, 17%, 45%, 16%, and 22%; for ABI, 21%, 43%, 16%, and 20%; P = .874). Primary patency was similar between groups at 12, 36, and 56 months (ADSI, 65%, 43%, and 32%; ABI, 69%, 34%, and 34%; P = .770), whereas ADSI patients showed an improved assisted primary patency (84%, 68%, and 54%) vs ABI patients (76%, 38%, and 38%; P = .008) and secondary patency. There was greater freedom from MALEs in the ADSI group (91%, 76%, and 64%) vs the ABI group (79%, 46%, and 46%; P < .001) at 12, 36, and 56 months of follow-up. ADSI patients were more likely to undergo an endovascular procedure as their initial post-SFA stent implantation intervention (P = .001), whereas ABI patients were more likely to undergo an amputation (P < .001). ConclusionsIn SFA stent implantation, patients with ADSI follow-up demonstrate an advantage in assisted primary patency and secondary patency and are more likely to undergo an endovascular reintervention. These factors are likely to have effected a decrease in MALEs, indicating the benefit of a more universal adoption of post-SFA stent implantation follow-up ADSI.

Severe radial artery spasm causing entrapment of the Terumo radial to peripheral destination slender sheath: a case report.

BackgroundRadial access for lower-extremity peripheral vascular interventions (PVIs) has been limited due to inadequate equipment lengths. The Terumo R2P Destination Slender sheath is a relatively new sheath designed for these interventions. However, complications related to this sheath or access strategy for lower-extremity PVI have not been reported.Case summaryA 69-year-old woman presented with purple discolouration of her 1st and 5th toes of the left foot for approximately 1 month. Lower-extremity arterial duplex ultrasound showed mid left superficial femoral artery (SFA) greater than 90% stenosis. Peripheral angiogram was performed via the left radial artery and this confirmed the presence of severe left SFA stenosis. Intra-arterial vasodilators including verapamil and nitroglycerine were administered to prevent radial artery spasm. Next, we attempted to deliver the Terumo 6-Fr R2P Destination Slender 119 cm sheath for the interventional procedure. However, the sheath became stuck at the level of mid axillary artery due to severe radial artery spasm. Despite use of intra-arterial vasodilators, deep sedation with propofol, and gentle retraction, the sheath could not be removed and eventually broke requiring surgical removal.DiscussionThis case demonstrates severe radial artery spasm causing sheath entrapment that required emergency surgery for sheath removal. Unfortunately, the sheath could not be removed despite typical manoeuvres for severe spasm including intra-arterial vasodilators and deep sedation with propofol. Physicians performing PVIs via radial access need to be aware of this potentially serious complication.

Evidence for temperature-mediated regional increases in cerebral blood flow during exercise.

Aerobic exercise elicits increases in cerebral blood flow (CBF), as well as core body temperature; however, the isolated influence of temperature on CBF regulation during exercise has not been investigated The present study assessed CBF regulation and neurovascular coupling during submaximal cycling exercise and temperature-matched passive heat stress during isocapnia (i.e. end-tidal was held constant) Submaximal cycling exercise and temperature-matched passive heat stress provoked ∼16% increases in vertebral artery blood flow, independent of changes in end-tidal and blood pressure External carotid artery blood flow increased by ∼43% during both exercise and passive heat stress, with no change in internal carotid artery blood flow Neurovascular coupling (i.e. the relationship between local increases in cerebral metabolism and appropriately matched increases in regional cerebral blood flow) is preserved during both exercise and temperature-matched passive heat stress ABSTRACT: Acute moderate-intensity exercise increases core temperature (Tc ; +0.7-0.8°C); however, such exercise increases cerebral blood flow (CBF; +10-20%) mediated via small elevations in arterial and metabolism. The present study aimed to isolate the role of Tc from on CBF regulation during submaximal exercise. Healthy adults (n=11; 10 males/one female; 26±4 years) participated in two interventions each separated by ≥48h: (i) 60min of semi-recumbent cycling (EX; 50% workload max) and (ii) 75min of passive heat stress (HS; 49°C water-perfused suit) to match the exercise-induced increases in Tc (EX: Δ0.75±0.33°C vs. HS: Δ0.77±0.33°C, P=0.855). Blood flow (Q) in the internal and external carotid arteries (ICA and ECA, respectively) and vertebral artery (VA) (Duplex ultrasound) was measured. End-tidal and were effectively clamped to resting values within each condition. The QICA was unchanged with EX and HS interventions (P=0.665), consistent with the unchanged end-tidal (P=0.327); whereas, QVA was higher throughout both EX and HS (EX: Δ16±21% vs. HS: Δ16±23%, time effect: P=0.006) with no between condition differences (P=0.785). These increases in QVA contributed to higher global CBF throughout both EX and HS (EX: Δ12±20%vs. HS: Δ14±14%, time effect: P=0.029; condition effect: P=0.869). The QECA increased throughout both EX and HS (EX: Δ42±58% vs. HS: Δ53±28%, time effect: P<0.001; condition effect: P=0.628). Including blood pressure as a covariate did not alter these CBF findings (all P>0.05). Overall, these data provide new evidence for temperature-mediated elevations in posterior CBF during exercise that are independent of changes in and blood pressure.

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Objective Asymptomatic carotid stenosis (ACS) is closely associated to the incidence of severe cerebrovascular diseases. Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke. This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors. The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data. All of the original data were retrieved from the China National Stroke Screening and Prevention Project (CNSSPP), including demographic, clinical and laboratory characteristics. The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1. The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled, 326 (11.6%) were diagnosed as ACS by ultrasonography. The top five risk factors contributing to ACS in this model were identified as family history of dyslipidemia, high level of low-density lipoprotein cholesterol (LDL-c), low level of high-density lipoprotein cholesterol (HDL-c), aging, and low body mass index (BMI). Their weights were 11.8%, 7.6%, 7.1%, 6.1%, and 6.1%, respectively. The total weight of the top 15 risk factors was 85.5%. The AUC values of the model for detecting ACS with training dataset and testing dataset were 0.927 and 0.888, respectively.Conclusions This study demonstrated that the machine-learning algorithm could be used to identify the risk factors for ACS among high risk population of stroke. Family history of dyslipidemia may be the most important risk factor for ACS. This model could be a suitable tool to optimize the clinical approach for the primary prevention of stroke.

An overview of the findings of dynamic upper limbs\u2019 arterial and venous duplex in cases of vascular thoracic outlet syndrome

BackgroundTo describe the findings of the dynamic upper limb arterial and venous duplex in the assessment of vascular compression in cases of VTOS. This study was conducted on 58 patients with VTOS; they were evaluated by dynamic duplex examination.ResultsVascular compression was subdivided into a venous compression that was detected in (84.4%, n = 49), arterial compression that was seen in (1.7%, n = 1), and combined arterial and venous compression that was present in (13.7%, n = 8); bilateral compression was existing in (94.4%, n = 55), compression at the scalene triangle was seen in (1.7%, n = 1), at the costo-clavicular space was seen in (91.3%, n = 53), and at the retro-pectoral space was depicted in (8.6%, n = 5).Complicated arterial compression was detected in (1.7%, n = 1), whereas venous complications were seen in (6.8%, n = 4).ConclusionDynamic duplex ultrasound offered a simple, noninvasive, and quick technique that can help in the evaluation of the vascular thoracic outlet syndrome without exposure to ionizing radiation or contrast media administration like that in CT; nevertheless, it is done with the patient in the upright position, thus avoiding the high false-negative results associated with the supine position that is used in the CT and MRI studies.

Combination of Nilotinib and Pegylated Interferon Alfa-2B Results in High Rates of MR4.5 at 24 Months - Primary Analysis of the ALLG CML 11 Pinnacle Study

Combination of Nilotinib and Pegylated Interferon Alfa-2B Results in High Rates of MR4.5 at 24 Months - Primary Analysis of the ALLG CML 11 Pinnacle Study

Are systolic velocity duplex metrics negatively affected by flow aliasing in areas of critical internal carotid artery stenosis

ABSTRACTPurpose: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis.Methods: Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%.Results: Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%.Conclusion: ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.

Spontaneous giant popliteal artery aneurysm

A 60 year old male presented with sudden onset of pain in right lower limb, difficulty in standing and antalgic gait since 3 days. There was no history of trauma. Examination showed a non-tender, compressible, pulsatile 10 x 6 cm swelling in the right popliteal fossa. His blood investigations were within normal range. Arterial duplex ultrasonography of right lower limb showed right sided popliteal artery aneurysm (PAA) with foci of thrombus in it. CT-angiography confirmed the findings. He underwent popliteal artery aneurysmectomy and interposition of graft. He was discharged on postoperative day 5. We will be describing a case of spontaneous giant PAA and discuss the protocol that we follow.

Physician Reimbursement for Vascular Surgery Procedures and Vascular Laboratory Studies Before and After the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution. PR for the following five VS procedures and three VL studies were obtained from our billing department: CPT 34803 (endovascular aneurysm repair), 35301 (carotid endarterectomy [CEA]), 35656 (lower extremity bypass [LEB]), 36010 (introduction of catheter into vena cava), 35200 (introduction of catheter into aorta [ICAo]), 93922 (ankle-brachial index), 93925 (lower extremity arterial duplex ultrasound), and 93970 (lower extremity venous [LEV] duplex ultrasound). The data were organized by payer: Medicare, Medicaid, commercial insurers (CIs), and other. PR was studied before the ACA (January 2008-December 2009) and after the ACA (January 2015-December 2016). The post-ACA PR and insurance-adjusted reimbursement (IAR) in 2016 dollars using the Consumer Price Index were calculated and compared using one-sample t-test. The percentage difference between the post-ACA PR and IAR was also compared. PR for 1704 VS procedures and 18,904 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare procedures (CEA, LEB, and ICAo) and Medicaid procedures (CEA, LEB, introduction of catheter into vena cava) and for ICAo for all payers. The post-ACA PR was significantly higher than the IAR for ankle-brachial index for all payers; lower extremity arterial duplex ultrasound for Medicare, other, and CIs; and LEV duplex ultrasound for Medicaid and CIs. Only Medicare LEV duplex ultrasound had post-ACA PR that was significantly lower than IAR (Table). The percentage differences for VS procedures were mostly negative for the Medicaid and Medicare groups but were more varied in the CIs and other payer groups (Fig). In comparing reimbursement before and after ACA implementation, PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support VS reimbursement, including higher valuation of the Medicare conversion factor.TableComparison of post-Affordable Care Act (ACA) reimbursement and insurance adjusted reimbursement (IAR)InsurancePost-ACA reimbursement, $IAR, $P valueCPT 34803, EVARMedicare1283.511174.92<.001Medicaid1141.831108.47N/AaOther1687.691126.51.659Private1720.491643.54.927CPT 35301, CEAMedicare1119.721300.93<.001Medicaid1033.181342.13.007Other1337.141315.60.912Private1817.951753.01.423CPT 35656, LEBMedicare947.811257.25<.001Medicaid963.371363.13<.001Other693.361258.27.248Private1713.051792.02.732CPT 36010, ICVCMedicare71.1280.22.444Medicaid67.3193.76.045Other457.03152.81.424Private146.99148.32.945CPT 36200, ICAoMedicare112.01185.09<.001Medicaid84.98172.73<.001Other255.14155.00.022Private208.36268.73<.001CPT 93922, ABIMedicare24.6011.74<.001Medicaid25.0711.10<.001Other31.0416.90<.001Private53.1122.47<.001CPT 93925, LEA duplex ultrasoundMedicare79.1940.43<.001Medicaid54.2336.18.298Other141.9234.24.014Private138.0454.94<.001CPT 93970, LEV duplex ultrasoundMedicare35.8246.41<.001Medicaid47.2830.17<.001Other43.9346.08.386Private93.3466.04<.001ABI, Ankle-brachial index; CEA, carotid endarterectomy; EVAR, endovascular aneurysm repair; ICAo, introduction of catheter into aorta; ICVC, introduction of catheter into vena cava; LEA, lower extremity arterial; LEB, lower extremity bypass; LEV, lower extremity venous; N/A, not applicable.aNumber too low for statistical calculation. Open table in a new tab

Stroke after lung biopsy

A 69-year-old man presented with a reduced level of consciousness and left hemiparesis immediately after a percutaneous CT-guided transthoracic needle lung biopsy, performed to investigate an interstitial pulmonary disease. CT...

The Relationship between Microalbuminuria and Atherosclerosis in Patients with Type II Diabetes and Evaluate the Parameters of Internal Carotid Artery Duplex Sonographic Scanning

The Relationship between Microalbuminuria and Atherosclerosis in Patients with Type II Diabetes and Evaluate the Parameters of Internal Carotid Artery Duplex Sonographic Scanning

Lower Extremity Pain - Field Hockey

Lower Leg Pain – Field Hockey HISTORY: A 20-year-old collegiate field hockey player 1 year, 2 months out from bilateral anterior/lateral/deep posterior compartment fasciotomies for chronic exertional compartment syndrome, recurrence of pain along her bilateral medial legs and medial/plantar foot numbness. Worsening over previous 6 months. Pain is daily, constant. Had MRI/MRA arterial duplex performed at onset of symptoms and was told it was negative. No improvement with neuropathic pain medication, physical therapy, hydrodissection. PHYSICAL EXAMINATION: Examination revealed healed surgical incisions. Mild scar hypertrophy along medial incisions with moderate tenderness to palpation. Full knee/ankle ROM. Pain reproduced with resisted ankle plantar flexion after 30 seconds, numbness along medial/plantar aspect of foot in tibial nerve distribution. Easily palpable dorsalis pedis/posterior tibialis pulses. DIFFERENTIAL DIAGNOSIS: 1. Recurrent chronic exertional compartment syndrome 2. Saphenous nerve compression neuropathy 3. Popliteal Artery Entrapment Syndrome TEST AND RESULTS: 1. Repeating compartment pressure testing: normal compartment pressures 2. EMG/NCS: normal without evidence of compression neuropathy 3. MRA (PRISMA 3T) study: forced plantarflexion demonstrates bilateral compression of the popliteal arteries at the popliteal fossa between the medial and lateral heads of the gastrocnemius muscle. FINAL/WORKING DIAGNOSIS: Popliteal Artery Entrapment Syndrome TREATMENT AND OUTCOMES: 1. Referred to plastic surgery colleagues. 2. Underwent bilateral popliteal artery releases 1 year, 8 months after index surgery. 3. Improvement of both pain and numbness along medial aspect of foot. 4. Last seen at 3 months post-operatively. Full, painless ROM. No pain with resisted plantarflexion. Normal sensation. Anticipate return to sport over the next 6 weeks.