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

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

3. 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

4. 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

5. 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

6. 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 cm Ap x 3.1 cm Lat.

7. 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

8. 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

9. Arteriogram of PSA

10. 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

11. 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: