Abstract
Dear Editor,
I enjoyed reading a well-written and very informative article titled “Sonographic Clues in Suspicion of Compartment Syndrome in a Lower Extremities Venous Study: A Case Study” published in the September/October 2021 issue of the JDMS. I just have a few questions about their presentation.
Figure 4 in the article shows “a transverse sonographic view of the popliteal artery with double pseudo-aneurysmal sacs”; however, there is no image that confirms “To-and-fro”—specific for pseudoaneurysms—spectral Doppler waveform. Incidentally, on page 488, it is written “to-and-flow,” which is just a typo. Moreover, neither the anterior nor the posterior pseudoaneurysm on Figure 4 demonstrates a neck that is typical of false aneurysms.
If Figure 4 reflects correctly the presence of two pseudoaneurysms, of the popliteal artery, filled with pulsating blood, their simultaneous rupture, as suggested in page 489, would have caused a catastrophic arterial hemorrhage (with both the anterior and posterior walls destroyed) rather than just “a large hole behind the knee.” There were no diagnostic images included from other modalities (e.g., magnetic resonance angiography or computed tomography angiography) that could have confirmed the author’s findings. I was unable to find any other articles describing double pseudoaneurysms of the opposite walls of the same artery.
I was surprised to read that the follow-up arterial examination 8 months after the femoral-tibioperoneal bypass graft surgery had included an ankle-brachial index (ABI) examination. I thought that the ABI examination is contraindicated in such cases because the inflation/deflation of a blood pressure cuff over or near the site of an arterial graft insertion might damage or rupture that surgical connection. Therefore, the toe-brachial index (TBI) examination is preferable (informative and safer) than the ABI. PPG waveforms within the TBI protocol could substitute for Doppler waveforms of the ABI. I also wanted to mention that besides the presence of the arterial graft in the upper calf, there was another contraindication for the follow-up ABI examination in that case: persisting thrombus in the posterior tibial vein of the ipsilateral leg.
I am looking forward to reading the author’s clarifications, which would be very helpful for all diagnostic vascular specialists wishing to learn more about that unusual pathology.
Kind regards,