PMC5487298_01
Initial angiography demonstrates thrombosis of the superficial femoral artery at the level of the adductor canal (A). More distal angiographic images demonstrate subacute distal embolization with minimal reconstitution of the anterior tibial artery (B) and no arterial flow to the foot (C).
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Initial angiography demonstrated thrombosis of the distal superficial femoral artery at the level of the adductor canal (Fig. 1A). More distal angiographic images demonstrated subacute distal embolization with minimal reconstitution of the anterior tibial artery (Fig. 1B) and no arterial flow to the foot (Fig. 1C).
Angiography (A) and three-dimensional volume-rendered images (B) demonstrate residual thrombosis and external compression of the superficial femoral artery at the level of the adductor canal.
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Angiography (Fig. 2A) demonstrated a much-improved result but residual thrombosis within the left superficial femoral artery at the level of the adductor canal. CTA of the chest and abdomen were normal. CTA of the lower extremities demonstrated external compression of the superficial femoral artery in the adductor canal along with the residual chronic thrombus within the superficial femoral artery at this level (Fig. 2B).
Intra-operative views showing approach to (A) and isolation of hypertrophied adductor magnus muscle compressing the superficial femoral artery in the adductor canal (B).
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A standard medial thigh approach was used (Fig. 3A). The area of arterial occlusion was identified and adjacent to this focal occlusion there was an impinging anomalous musculotendinous band compressing the left superficial femoral artery (Fig. 3B).
Intra-operative views showing (A) the superficial femoral artery following division of the hypertrophied adductor magnus muscle, (B) thrombotic occlusion discovered after arteriotomy, (C) specimen following thromboendarterectomy and (D) and the superficial femoral artery following patch angioplasty.
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The anomalous musculotendinous band was divided using electrocautery (Fig. 4A). Thromboendarterectomy of the distal left superficial femoral and above knee popliteal artery was performed (Fig. 4B & C). After flushing and backbleeding, a bovine pericardial patch was sewn in place using a 6-0 Prolene suture (Fig. 4D).
Post-operative arterial duplex ultrasound (A, B & C) and lower extremity Doppler examination with ankle brachial indices (D) following division of the hypertrophied adductor magnus muscle, superficial femoral artery thromboendarterectomy and patch angioplasty using bovine pericardium.
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Post-operative arterial duplex ultrasound (Fig. 5A-C) and lower extremity Doppler examination with ankle brachial indices (Fig. 5D) demonstrate normal lower extremity arterial perfusion following our extensive efforts.