PMC9083547_01
Discrete patchy gangrenous lesions in the left foot in keeping with distal thromboembolism 'Trash foot' (black arrows).
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Approximately 24-36 hours afterwards, she developed acute limb ischemia with multiple gangrenous patches in her foot and toes suggestive of a 'trash foot' (Figure 1), prompting a vascular referral.
(A) Duplex ultrasonography demonstrating the characteristic turbulent spectral pattern of an arteriovenous fistula (AVF); (B) Computed tomography angiography (axial) demonstrating the presence of high-density contrast in femoral vein suggestive of an AVF (blue arrow); (C) Computed tomography reconstructed image of left superficial femoral artery (SFA) indicating the presence of thrombus in the SFA (white arrow).
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Imaging further revealed a thrombus in the SFA just distal to the AVF (Figure 2).
Operative images of the left superficial femoral artery reconstructed with an interposition vein graft after discontinuing the arteriovenous fistula.
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The catheter-inflicted SFA injury was such that a 4 cm segment was excised and repaired with an interposed reversed vein graft (Figure 3).