Electrodiagnostics: There is evidence of an old peroneal motor and sensory nerve injury consistent with multiple ankle inversions injuries.
Ankle Brachial Indices: The right resting ankle/brachial indices are within normal limits. The left resting ankle/brachial indices are suggestive of moderate peripheral vascular occlusive disease (PVOD). The right resting segmental pressures are within normal limits. The left resting segmental pressures are suggestive of popliteal disease. The left resting segmental waveforms are suggestive of tibial-peroneal disease.
The patient exercised at 2.0 mph for 4 minute(s) and 30 seconds at an elevation of 10%. Exercise was terminated early due to lower extremity cramping. The right lower extremity remained within normal limits. The left lower extremity dropped into the severe PVOD category and did not return by the 5th minute.
Arterial Duplex: The left distal femoral, popliteal, gastrocnemius, and distal posterior tibial arteries were imaged. There was no evidence of aneurysm or cyst. The popliteal and posterior tibial arteries display very low velocity, minimal scattered color flow and low amplitude waveforms. Velocities are as listed: distal femoral artery: 56cm/s; popliteal artery: 14cm/s; gastrocnemius artery: 65cm/s; posterior tibial arteries distal: 21cm/s.
Computed Tomography of Chest, Abdomen, Pelvis, and Run-off:
Occlusion of the left popliteal artery just distal to the origin of the left superior genicular artery. More distally in the left leg, there is reconstitution of the left popliteal artery via multiple collateral vessels around the knee. At least moderate narrowing of the right popliteal artery in the similar location as the left, although it is not occluded. Case Photo #1
Vascular Surgery was consulted and confirmed an occlusion of popliteal artery with differential diagnosis including adventitial cyst, popliteal aneurysm, popliteal entrapment, or embolic phenomenon. Computed tomography of chest, abdomen, pelvis, and run-off was ordered. Results listed above.
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