General Surgery Resident Henry Ford Health Chesterfield, Michigan, United States
Introduction/Purpose: Spontaneous, atraumatic iliac artery dissections within highly trained athletes are becoming more recognized, but the reason as to why they are occurring is not. With very few documented case reports of external iliac artery dissections after completion of an athletic event currently known, the patient involved in this case report combines this rare phenomenon in conjunction with intermittent use of hormone replacement therapy. A 54 year old male with a past medical history of portal vein thrombosis along with use of HRT presents to the emergency room with acute right leg pain and increasing numbness after lifting weights in his home. CTA was completed showing an acute occlusion of the right common femoral artery leading to diagnosis of acute limb ischemia.
Methods or Case Description: Patient was taken to the operating room for emergent thrombectomy of the right extremity. Upon incision and dissection the tissue planes were noted to be blood tinged in appearance, that similar of traumatic injury, with findings consistent with acute dissection along the lateral wall of the superficial femoral artery. Wire access was obtained and an angiogram completed showing dissection extending up to the proximal aspect of the common femoral artery. Covered stents were placed within the true lumen of the CFA and external femoral artery along with resection of damaged SFA, placement of PTFE interposition graft, and lower leg four compartment fasciotomy. Patient had strong PT/DP signals post-operatively.
Outcomes: After further discussion with the patient in light of findings consistent with a traumatic injury, he denied any recent trauma endorsing only flexing his quadricep muscles leading to a popping sensation and sudden pain. It was then discovered patient had recently been taking testosterone and HRT to supplement his weight lifting results. With his history of portal vein thrombosis hematology was involved which revealed no genetic component to his presumed hyper coagulable state. Of note, patient had not been taking any anticoagulation after finding of PVT years prior. Patient did develop a moderate case of foot drop which has slowly improved. A split-thickness skin graft was also completed to aid in closure of the fasciotomy incisions. Overall, patient is doing well with most recent ankle brachial index of 1.0.
Conclusion: This case is a great example of a small known population of physically active patients with instances of acute femoral artery dissection of no true known cause. Although this patient was intermittently partaking in HRT, his presentation overall still raises the question of validity to increased risk in psoas muscle hypertonicity along with repetitive activity of the muscles surrounding the femoral canal.
