Calf Pseudoaneurysm found During Routine Venous exam Deneen Ferraro RVT, RPhS Technical Director Vein Center at Allure Medical Spa

Thank you for sponsoring MVA Charles Mok D.O. RPVI Medical Director Vein Center of Allure Medical Spa

Tunica Intima Tunica Media Tunica Externa Before we get started on the case study, arteries have 3 layers, the Tunica Intima, Tunica media and Tunica Externa Tunica Intima Tunica Media Tunica Externa

True aneurysms involve all three layers True aneurysms involve all three layers and Pseudo aneurysms do not, they involve only one layer, True aneurysms involve all three layers

Posterior Tibial Artery PSA PSA’s also have a neck from the artery that is the source , in this case it is the Posterior Tibial artery, This 31 year old female came in for a venous insufficiency exam, presenting with Varicose Veins bilaterally as well as leg pain. Posterior Tibial Artery PSA

Upon Duplex examination , a large PSA was identified off the PTA, questioning the patient , she had no previous surgeries on this leg and had 2 years prior experienced a sudden onset of pain in that leg, at that time no imaging was performed and she was prescribed conservative treatment. Pointer ****PSA ‘s typically have thrombus present*** PSA 4.2cm Ap x 3.1 cm Lat.

To-Fro flow typical to PSA One way to differentiate that this pulsatile mass is a PSA is the typical to-fro pattern of the doppler signal To-Fro flow typical to PSA

high velocity flow in psa neck Another way- is to find the source of the PSA, The NECK, it will have a high velocity, high resistant doppler signal . This patient was referred to Dr. Johnson , and received a successful and minimally invasive coil embolization. She returned to us and had venous ablation on that leg and had complete resolution of her leg pain. high velocity flow in psa neck

Arteriogram of PSA

Venous involvement vs dampened Reverse flow Some pitfalls when scanning, it can appear to have a venous component to them as the flow swirls around and FALLS off the back wall and is very low flow and retrograde Venous involvement vs dampened Reverse flow

With enough manipulation this can occur to appear as venous flow when actually it is just inside the swirl of the high velocity arterial flow and is barely moving. Pitfalls: