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Wave 2: Module 2: Lower Limb – Week 7 – Case 1
42 years old male cyclist presented to the vascular clinic with recent history of left leg claf and thigh claudication
No past medical history and non-smoker
ABPI is 0.9 on rest and drops to 0.6 on exercise
Weak femoral and leg pulses on left side
Duplex scan shows diminished PSV on femoral segment and MRA shows
What is your diagnosis
What is the plan of management
What is post operative advise to the patient
27 Comments
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Diagnosis : Endofibrosis of left external iliac artery
Management: Endarterectomy with venous patch or interposition graft
Postop advise : Limiting of vigorous cycling to avoid aggressive flexion of the hip with anti platelets to keep patency of the graft & follow-up
1.Endofibrosis of external iliac artery
2. Endartectomy +/- IP
3. Limitation if the vigrous activity and cylcing, cotinuation of the antiplatet for patency of the graft
Q1 What is your diagnosis
Most probably Endofibrosis of LT Iliac artery.
Q2 What is the plan of management
Open: LT CFA endarterectomy with patch closure or interposition graft.
Q3 What is post operative advise to the patient
A1 endofibrosis of lt EIA
A2 endartrectomy with venous patch
A3 stop cycling to prevent repetitive trauma to the artery
Q1 endofibrosis of the left iliac artery
Q2 endarterectomy with venous patch closure or venous IP
Q3 stop cycling and frequent follow up
endofibrosis if the left iliac artery
open repair with endarterectomy and patching and if needed interposition graft
limit cycling and vigorous activity involving the extensive flexion of the hip joint
A1
Endofibrosis of LT Iliac artery.
A2
LT CFA endarterectomy
A3
cessation of cycling to reduce repetitive trauma.
FOLLOW UP
Q(1):
Most probably Endofibrosis of LT Iliac artery.
Q(2):
Open: LT CFA endarterectomy with patch closure or interposition graft.
Q(3):
Life style modification and cessation of cycling to reduce repetitive trauma.
Adding antiplatelet for patency of the graft.
Endofibrosis of iliac art
Best ttt via endarterectomy with patch or interposition graft
Risk factor modification and follow up
Very good answer
1- case of CTLI most propably due to endofibrosis of iliac artery
2- life style modification to decrease repeated truma , psychological reassurance
Prepare for surgical interference
Interposition graft / endarterectomy + angioplasty
3-
Post ttt
Avoid repeated stressful truma
Anti plt to avoid graft thrombosis
I don’t think the case falls under definition of CLTI
I agree with diagnosis of endofibrosis
Angioplasty would have very limited role in such cases
I would agree with surgical intervention
Thanks for the answer
1-iliac artery endofibrosis
2-surgical excision of stenotic segment and replace by interposition synthetic graft or endarterectomy w closure by venous patch
3-stop cycling replace by walking
Close follow up by cta +_ duplex
Start anti platelets
Good approach, well done
Endofibrosis of iliac artery
Ttt open Interposition graft
Antiplateles should be considered to avoid intimal hyperplasia at sites of anastomses
Main advise is to avoid vigourous hip flexion and may quitting cycling
perfect answer
A1..
Endofibrosis of iliac artery
A2..
It is treated surgically by excision of the segment and interposition graft or patch-plasty
A3..
Post operative I will advice the patient to change his life style by practicing another sport
Keep on antipletlet therapy and follow up to check patency og the graft
Perfect answer
Iliac artery endofibrosis
Surgical management patch Vs interposition Graft
Avoid bicycling And repetitive vigorous flextion of hip
Perfect, what do you think surveillance and anti platelets/anticoagulation plan post op?
Q1:
I think the case is endofibrosis or cystic advetitial disease
Q2:
Surgical intervention by endarterectomy with patching or Interposition graft
Q3:
Quit aggressive exercise with anti platelets therapy postoperative
Very good , thanks
Q1:
endofibrosis of left external iliac artery in a cyclist presented with IC
Q2:
arrangement for endarterectomy and patch or Interposition graft
Q3:
stop riding bicycles or doing vigorous exercise which put high pressure at the level of the hip joint
well done , good answer
What do you think post operative surveillance and anti platelets/anticoagulation plan please?
post operative surveillance is also recommended
about anti-platelet or anticoagulant i think the pathology here is different it is a case of non atherosclerosis cause of IC
Good
Do you think post surgical repair in iliac segment , anti platelet regime would be recommended?
totally agree antiplatelet is recommended specially in the early period to avoid early platelet aggregation
but when you sir asked me earlier i searched for recommendation i found a study named PROOVIT study which concluded (Neither AC nor AP alone, nor in combination , impact complication rate after arterial repair with autologous vein)