A Rare Case of Bilateral Popliteal Artery Occlusion

Abstract

Peripheral arterial disease (PAD) is a common condition of the upper and lower extremities caused by atherosclerosis. It is often accompanied by symptomatic cardiovascular and cerebrovascular disease and is a major risk factor for amputation of an extremity. Timely diagnosis and intervention can prevent morbidity in these patients. We describe a case of a 48-year-old man with multiple co-morbidities who presented to our emergency department (ED) complaining of acute onset of bilateral leg pain. He was found to have bilateral acute popliteal artery occlusion confirmed by angiography of the lower limbs. Treatment was started early, right after reaching the provisional diagnosis.Popliteal artery occlusion is quite common, but it becomes a rare diagnosis when it happens bilaterally. Detailed evaluation of the peripheral arterial circulation and an early diagnosis seem to be important in the ED management of these patients.

An old but still valuable technique for popliteal artery stenosis: Endarterectomy via the posterior approach

“…The clinical status of patients with popliteal artery occlusion is variable, and patients can have intermittent claudication, critical ischemia, or acute thromboembolism, depending on whether there is any accompanying pathology in other vascular segments according to the level of involvement in the artery. [6] The complaints at presentation in our patients were mainly intermittent claudication and resting pain. Limb ischemia was serious in 11 (78.5%) patients at Fontaine Stages 2b and 3, and the ABI was <0.7.…”

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“…Additional factors contributing to leg pain may involve cellulitis, psychogenic origins, and fibromyalgia. Atherosclerosis plays a significant role in vessel narrowing and subsequent distal ischemia [17].…”

“…Physical evidence of obstruction of total occlusion of the popliteal artery is the absence of a pulse in the peripheral arteries, such as dorsal pedis and tibialis posterior, evaluation of capillary refill time, and oxygen saturation [10]. Clinical assessment of ALI should include the duration of symptoms, pain intensity, and severity of motor and sensory deficits [17]. When the six clinical signs of acute ischemia in the injured limb are observed, which include pain, pulseless, pallor, perishing cold, paraesthesia, and paralysis, it is crucial to perform imaging tests to assess the condition of the popliteal artery.…”

“…The absence of an arterial signal indicates that the limb is threatened. Losing both arterial and venous signals means the limb may be irreversibly damaged [17]. The approach to managing suspected vascular injuries in the lower limb has shifted over time, moving from mandatory exploration to routine imaging.…”