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Using a hybrid approach to management of a common femoral arterial dissection
  1. Hiromu Maehara1,
  2. Taketo Kurozumi2,
  3. Hiroshi Kondo3,
  4. Tetsuya Sakamoto1,
  5. Kaori Ito1
  1. 1Division of Acute Care Surgery, Department of Emergency Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
  2. 2Trauma and Reconstruction Center, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
  3. 3Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
  1. Correspondence to Dr Kaori Ito; kaoriito1{at}gmail.com

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A middle-aged (fifth decade) patient was brought to the emergency department after a motorcycle collision during which the lower abdomen-to-pelvis area was trapped between a traffic sign pole and the motorcycle. On admission, vital signs were normal. The patient complained of left groin and buttock pain. Primary and secondary evaluations revealed subcutaneous hematoma and tenderness in the groin bilaterally and left buttock. Left dorsal pedis arterial pulse was slightly diminished compared with that on the right. No neurological deficits were apparent in bilateral lower extremities (LEs). Laboratory test results were unremarkable. Contrast-enhanced CT revealed a defect in the left common femoral artery (CFA) with normal runoff. Scans also identified a sacral bone fracture with contrast medium extravasation and a pseudoaneurysm with a large subcutaneous hematoma in the left gluteus maximus muscle (figure 1A,B).

Figure 1

(A) Contrast-enhanced CT shows that the left common femoral artery is not visible (circle). (B) Gluteal hematoma (thick arrow) with extravasation of contrast medium from the left inferior gluteal artery (thin arrow).

As the vascular surgery, interventional radiology, and orthopedic departments were planning treatment, the patient, now tachycardic and diaphoretic, complained of worsening pain and numbness in the left buttock and LEs. Examination showed that …

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