A 58-year-old man with a history of thrombocytosis presented with acute left lower extremity ischemia. He had no femoral pulse on the left and no Doppler signals in the left foot. Paresthesia and some weakness of left foot were present. The right leg had normal femoral, popliteal, and pedal pulses. He was in normal sinus rhythm.
The patient was taken to the operating room with a presumptive diagnosis of thrombosis secondary to a hypercoaguable condition. On opening the femoral artery for thrombectomy, there was no thrombus within the artery and the artery was essentially empty. No antegrade flow could be established. Aortic dissection with occlusion of the left iliac was suspected. A femoro-femoral bypass was performed to revascularize the left leg, and the the patient underwent a CT scan in the immediate postoperative period. The CT scan demonstrated a dissection involving the ascending aorta and continuing into the left common iliac artery. Note the decreased contrast density in the left iliac due to the intimal flap.