0:00

So this is actually a follow-up of that same patient we just saw, the one with the

0:04

patent femoral popliteal and popliteal

0:08

anterior tibial artery venous grafts.

0:11

This patient had an interval scan because they came with new

0:15

symptoms, and as you can see now, as we're scrolling, there

0:19

is no contrast opacification of this bypass graft anymore.

0:23

We see that deep femoral is reconstituted by some

0:27

collaterals. However, the graft itself

0:30

is not opacified, and the rest of the arteries in the

0:34

contralateral as well as the ipsilateral limb are opacified, so it's not like we've

0:38

outrun the bolus. But there is definitely thrombosis of this

0:41

entire bypass graft leading all the way up till the anastomosis.

0:46

Now, that second bypass graft that we had, which was here, the

0:51

bypass graft to the anterior tibial artery, that is also not showing

0:55

opacification. Now, if this was a de novo scan,

0:59

chances are hopefully you wouldn't have missed it because you would have noticed

1:01

these surgical clips. But it's always important to review that surgical

1:05

anatomy and interventions a patient has had in the past

1:10

before we make an assessment. We also have an immediate delay just in case you

1:13

needed to problem solve and make sure that there's definitely no

1:17

opacification or sluggish opacification of that bypass

1:21

graft at all, neither at that femoral popliteal

1:24

level nor the bypass graft to the anterior tibial artery

1:28

level.