title: Spontaneous dissection of the popliteal artery in a young man. A rare cause of the blue toe syndrome.
abstract: Spontaneous arterial dissection in peripheral arteries of the extremities is an extremely rare event. We report a case of a spontaneous dissection of a nonaneurysmal popliteal artery in an otherwise healthy 36-year-old man that came to clinical attention as an acute blue toe syndrome. The diagnosis was primarily made by high-resolution duplex ultrasound that revealed a dissection flap (length: 15.5 mm; thickness: 0.4 mm) together with the partially thrombosed false lumen at the dorsal wall of the left popliteal artery (degree of local diameter reduction: 56%). Further work-up by means of contrast-enhanced MR-A and conventional DSA confirmed a moderate stenosis of the popliteal artery compatible with focal dissection and excluded other causes such as popliteal artery entrapment syndrome. Under full-dose intravenous anticoagulation with unfractionated heparin that was switched to oral anticoagulation with vitamin K antagonists (target INR: 2-3) and conservative management of the blue toe the patient made a gradual, but eventually complete clinical recovery over 8 weeks.
authors.affiliation: Department and Clinic of Angiology, University of Essen, Essen, Germany. c.kuegler@hgz-bb.de
authors.forename: C F A
authors.initials: CF
authors.lastname: Kügler
authors.forename: M
authors.initials: M
authors.lastname: Poser
authors.forename: F
authors.initials: F
authors.lastname: Mosel
authors.forename: S
authors.initials: S
authors.lastname: Ruehm
authors.forename: G
authors.initials: G
authors.lastname: Rudofsky
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications*; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D018438:Blue Toe Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D004359:Drug Therapy, Combination; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D014463:Ultrasonography; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D006493:Heparin