Successful Bypass Surgery in a Healthy 24-Year-Old Male with Peripheral Artery Disease.

Approximately 40% of peripheral artery disease cases occur in individuals less than 50 years old. Diagnosis is often delayed due to fewer risk factors, atypical presentation, and symptoms attributed to a benign cause. We present an unusual case of an otherwise healthy 24-year-old male presenting with unilateral, intermittent claudication (IC) due to diffuse atherosclerotic disease in his left femoral arteries. Lifestyle-limiting symptoms caused by a four-year delay in diagnosis were improved with successful left femoropopliteal bypass. We use this case to review the differential diagnosis for IC and recommend early revascularization in young patients with severe disease and few comorbidities.

A Case of Spontaneous Isolated Celiac Artery Dissection with Pseudoaneurysm Formation.

Spontaneous isolated celiac artery dissection is a rare disease and patients without evidence of significant complications often resolve with medical therapy alone; however, the extension of the dissection can lead to more serious complications including aneurysmal dilatation, complete occlusion, and rupture of a visceral artery. In these patients, optimal management has not yet been clearly defined and treatment primarily depends on clinical presentation and lesions identified on imaging studies. This case report demonstrates the conservative management of spontaneous celiac artery dissection. A 49-year-old male presented to our emergency department with acute and persistent abdominal pain. A contrast-enhanced computed tomogram (CT) of abdomen showed a pseudoaneurysm involving the ostium of the celiac artery with focal dissection, with no evidence of thrombosis or infarction to the visceral organs. Ultrasound studies demonstrated a prominent but patent celiac artery with adequate distal perfusion. Therefore, conservative medical management with antiplatelet therapy was initiated in our patient. Follow-up repeat ultrasound three weeks following discharge showed no evidence of dissection flap, stenosis, thrombosis or increase in the size of the aneurysm. This case report demonstrates that conservative medical management with antiplatelet therapy can be sufficient in treating spontaneous isolated celiac artery dissection with pseudoaneurysm formation. We suggest endovascular or surgical intervention should be reserved for patients who present with hemodynamic instability, or other serious complications, such as aneurysm rupture or visceral infarction.