59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe. Comprehensive workup for an embolic source demonstrated a focal plaque in the popliteal artery. Catheter angiography showed the ulcerated plaque. Directional atherectomy using a SilverHawk atherectomy device was performed. Patients symptoms resolved and at last follow up 2 years later, the patient had no recurrence.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.
22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT).
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.