1Husameddin El Khudari, 1Manuel Betancourt-Torres
1University of Alabama at Birmingham, Birmingham, United States
A 70 year-old-female patient with a history of atrial fibrillation, mitral valve replacement, hypertension, hyperlipidemia, hypothyroidism, and TIAs. The patient was admitted to our institution with a posterior cerebral artery infarct. An echocardiogram from the outside hospital revealed a frozen thrombosed mitral valve leaflet. CTA was performed for vascular evaluation prior to robotic mitral valve replacement. CTA revealed hypoplastic left common, external and internal iliac, as well as common and deep femoral arteries. The left superficial femoral artery is not clearly identified suggesting either thrombosis or congenital absence. The right iliofemoral vessels have a normal caliber. Scattered atherosclerotic plaques throughout the iliofemoral vessels bilaterally. The kidneys and urinary bladder are normal. There is significant asymmetry in the thickness of the left femoral shaft cortex in comparison with the right, also the bone density at the left femoral head appears significantly lower. There is also left thigh and gluteal muscle atrophy in comparison to the right.
Congenital malformation of the iliofemoral arteries are rare and usually discovered incidentally at autopsy or during workup for other conditions. The exact prevalence is unknown. Greeb identified no more than 6 cases by pelvic angiography in a series of 8000 symptomatic patients. Most reported cases are associated with a persistent sciatic artery. Complex genitourinary malformations are sometimes associated with these anomalies. Congenital malformation of the external iliac artery has been classified into three groups by Tamisier et al.
We presented a case of incidentally discovered left iliofemoral hypoplasia during workup for robotic mitral valve replacement. The patient was asymptomatic, however, these anomalies may lead to problems in the future, in the event of atherosclerosis and/or thrombosis.