Distal Bypass / Right-Sided PAOD Stage III
Clinical History
This 73-year-old female with long-segment occlusion of the right superficial femoral artery had received a P3 (below-knee) femoropopliteal bypass graft using prosthetic material 5 years ago. The present examination was performed because of a progressive decrease in walking distance to less than 30 metres at the last examination.
MR Imaging
MR imaging was performed using a Siemens Avanto MR scanner (1.5 T). For further details please click the link below.
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Fig. 1. MIP of the 3D-MRA in the first-pass phase (see table for sequence parameters). Depiction of several irrelevant stenoses of the distal bypass and a severe stenosis of the bypass anastomosis (arrow).
Fig. 2. Curved MPR of the corresponding vascular segment in the unsubtracted series of the first-pass phase (see table above for sequence parameters). The anastomosis stenosis is now clearly visible (arrow) but the mural thrombus can only be guessed at (dotted arrow).
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Fig. 3 - 4. Curved MPR [3] and axial reconstruction [4] of the distal bypass segment in the steady-state phase (see table above for sequence parameters). Excellent visualization of the mural thrombus (dotted arrow).
Diagnosis
1.) Significant stenosis at the anastomosis after femoropopliteal P3 (below-knee) bypass grafting with artificial material.
2.) Mural thrombus in the distal segment of the prosthetic bypass graft.
Authors
T. Albrecht, MD, B. Meyer, MD, and B. Frericks, MD, Charité - Campus Benjamin Franklin, Berlin, Germany. Patient was examined at the Imaging Science Institute Siemens - Charité, Berlin.