Ultrasound Findings of a Popliteal Arteriovenous Fistula and Pseudoaneurysm Following a Total Knee Replacement

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Ultrasound Findings of a Popliteal Arteriovenous Fistula and Pseudoaneurysm Following a Total Knee Replacement

Thuy Nguyen, Hoag Memorial Presbyterian Hospital, Newport Beach, CA

 Introduction/Patient Description
A popliteal arteriovenous fistula (AVF) combined with a pseudoaneurysm following a total knee replacement is rare considering overall vascular complications in knee arthroplasty is less than 0.005 percent of cases. This case reports an uncommon finding by duplex imaging of a pseudoaneurysm and an arteriovenous fistula at the popliteal level. The patient was successfully treated by endovascular repair of the right popliteal pseudoaneurysm. The AVF was treated with three Gore Viabahn covered stent grafts. A 63-year old man with a history of hypertension and diabetes presented to the emergency department for persistent right calf pain 3 weeks after right knee replacement. The physical exam showed swelling of the right calf and ecchymosis tracking down to the ankle, palpable distal pulses and a “thrill” in the right popliteal fossa.

Methods
Right lower extremity duplex imaging was performed with cine-loop B-mode (Philips iE 33), color and spectral Doppler using a L9-3MHz linear-array transducer. Dynamic images of the right popliteal artery and vein were obtained in one to three seconds time duration.

Results
Dynamic duplex imaging of the right popliteal artery and vein identified disturbed, high diastolic flow in the popliteal artery, and pulsatile arterialized venous flow in the popliteal vein suggestive of an A-V fistula. Both popliteal artery and vein are communicating with the pseudoaneurysm. The CTA of the right popliteal artery reported the pseudoaneurysm was not-well visualized due to streak artifact from the adjacent knee arthroplasty; however, it was noted arising from the infrageniculate popliteal artery. In addition, early filling of the popliteal vein suggested an arteriovenous fistula.

Conclusion/Discussion
Ultrasound is a noninvasive and effective imaging modality to evaluate hemodynamic flow in cases suspicious for pseudoaneurysm and arteriovenous fistula after arthroplasty for a prompt diagnosis. Ultrasound is proven efficient and plays an important role in the treatment for these patients.

 

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Presented by

Thuy Nguyen, Hoag Memorial Presbyterian Hospital, Newport Beach, CA

Presented By

Thuy Nguyen, RVT RDMS

Vascular Ultrasound Technologist
Hoag Hospital, Newport Beach, CA