Archie R. McGowan, MD

Disclosures

December 14, 2004

Abstract and Case Summary

An 86-year-old woman presented with vague abdominal pain and a computed tomographic (CT) study was ordered. Her medical history includes heart failure and hypertension.

An 86-year-old woman presented with vague abdominal pain and a computed tomographic (CT) study was ordered. Her medical history includes heart failure and hypertension. Her surgical history includes coronary artery bypass graft (CABG) surgery in 1986 and a hysterectomy. An incidental finding was noted on an axial slice from a CT study of the abdomen and pelvis (Figure 1). Further imaging studies were performed, including ultrasound and angiography (Figures 2 through 5).

There is significant asymmetry in the caliber of the proximal superficial femoral veins on this axial slice from a CT study of the abdomen and pelvis. The much larger right vein is seen to splay the adjacent superficial and deep femoral arteries.

Ultrasound waveform analysis reveals loss of the normal triphasic peripheral vessel wave form and presence of brisk forward diastolic flow consistent with low resistance.

Color Doppler ultrasound image shows a fistu-lous connection between the proximal superficial femoral artery and the superficial femoral vein. A palpable hum was felt while scanning this area.

(A) Digital subtraction angiography reveals early venous filling via a fistula connecting the superficial femoral artery and vein. (B) Later angiographic image shows the brisk venous return of contrast via the pelvic veins to the inferior vena cava.

(A) Digital subtraction angiography reveals early venous filling via a fistula connecting the superficial femoral artery and vein. (B) Later angiographic image shows the brisk venous return of contrast via the pelvic veins to the inferior vena cava.

(A) The fistula is seen just caudal to the takeoff of the deep femoral vessel. The superficial femoral vein demonstrated dilatation, but a patent upper thigh valve prevents caudal reflux, explaining the clinical absence of asymmet-ric lower-extremity swelling. (B) The Wallgraft (8-mm x 2-cm covered stent) (Boston Scientific, Watertown, MA) is shown just below the takeoff of the deep femoral artery. The fistula is closed and the palpable thrill ceased.

(A) The fistula is seen just caudal to the takeoff of the deep femoral vessel. The superficial femoral vein demonstrated dilatation, but a patent upper thigh valve prevents caudal reflux, explaining the clinical absence of asymmet-ric lower-extremity swelling. (B) The Wallgraft (8-mm x 2-cm covered stent) (Boston Scientific, Watertown, MA) is shown just below the takeoff of the deep femoral artery. The fistula is closed and the palpable thrill ceased.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....