0:00

Our next patient is a young male with a

0:04

hundred pack year history and a prior left below-knee

0:08

amputation.

0:10

Histologically, they've been proven to have thromboangiitis obliterans

0:14

or Buerger's disease, and knowing that history

0:18

is helpful. And

0:20

we're going to discuss some clues on when to raise suspicion of this disease

0:24

when you might not have histological confirmation already.

0:28

So coming down and looking at the vessels, the inflow

0:32

does have some atherosclerosis, but there's no

0:35

high-degree stenosis. It's just

0:38

mild stenosis, mild plaque along the aorta, as well as both

0:41

common iliac arteries and the external iliac arteries on both

0:45

sides. We're going to look at the left side first.

0:49

There's occlusion of that superficial femoral

0:52

artery and really the profunda femoris artery is the main supply to

0:56

that stump that's on the

0:59

left side. As I mentioned, they've had a below-knee amputation.

1:03

All right. Focusing now on the right side.

1:05

So

1:06

there's no significant stenosis, just mild stenosis of the external

1:10

iliac artery as well as the common femoral artery, and then the superficial

1:14

femoral artery as we're scrolling down.

1:17

As we're scrolling down even further, there remains mild

1:21

stenosis of the popliteal artery.

1:25

And as we scroll down further,

1:28

we don't really see opacification of the tibia peroneal trunk and the posterior

1:32

tibial artery on these arterial phase images.

1:34

And there's really just a one vessel runoff via the anterior

1:38

tibial artery that forms the dorsalis pedis artery.

1:42

And so in cases like this, we would say for the right

1:47

lower extremity, patent femoral popliteal vessels,

1:51

one vessel runoff by the anterior tibial artery, and

1:55

occluded posterior tibial and peroneal arteries.

1:57

It's always good to confirm that on our

2:01

delayed phase images. So if I put both the

2:05

arterial and the delayed phase together, I think this is a great example

2:09

to show.

2:11

So arterial here and delayed over here, and if we're going

2:15

to focus on both of these all the way down in the leg

2:19

arteries.

2:20

So right here, we didn't really see much opacification at all

2:24

of the entire

2:27

posterior tibial and peroneal artery system when we were looking at the

2:31

arterial phase images. But if you look at that delayed phase image, then

2:35

you can see that there is some faint reconstitution

2:38

here

2:39

of the posterior tibial and peroneal artery images via

2:43

collaterals.

2:45

And this is an example again of the bolus

2:48

outrunning and looking at the delayed phase

2:52

images definitively before calling any

2:56

vascular segment thrombosed, and not just

2:59

interpreting based on that first pass arterial phase images.