Authors

• Ivana Jurin — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-2637-9691
• Anđela Jurišić — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0001-8316-4294
• Jasmina Ćatić — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0001-6582-4201
• Sanda Sokol Tomić — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-4551-9231
• Ana Jordan — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0001-5610-6259
• Irzal Hadžibegović — Klinička bolnica Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-3768-9134

Abstract

**Case report:** We are presenting two clinical cases of patients with patent foramen ovale (PFO). The first case is 46-years-old woman with a negative history of cardiovascular disease. After the fourth pregnancy, a progression of the right-sided saphenofemoral insufficiency was verified and an operative procedure was indicated. On September 14, 2017 the VSM was extirpated. On the first postoperative day a right-sided hemiplegia emerged and the brain MSCT confirmed the occlusion at the level of the left ACM. A thrombectomy of the acute occlusion of the left ACM was performed, which resulted in complete recanalization of the left ACM. The next day, a massive pulmonary embolism was diagnosed. We verified the PFO by echocardiography and concluded that the PFO was trigger of these adverse events. The second case is 46-years-old woman whose family history is positive for cardiovascular disease. For several years, 24-hours ECG has verified paroxysms of supraventricular tachycardia. Because of the pain in the right ankle and in the absence of trauma, Doppler echo showed us occluded right ADP. From the medical history it was known that woman often wears high heels and tight boots, which makes foot positioned in the plantar extension. An extensive treatment was performed, the immunological treatment was neat and the echocardiography verified PFO. Considering that we could have not clearly distinguish Doppler echo from the occluded aneurysms, intramural hematoma or peripheral embolization, additional treatment was done. CT angiography of the foot verified an occluded ADP on the right which was well collateralized and the 70% stenosis of the left ADP. It was a both sided aneurysm of ADP due to plantar extension, precisely “Sandal strap” trauma and atherosclerosis. **Conclusion:** Although the PFO is more common cause of peripheral embolization (1, 2), as we have shown in the first case, here we wanted to emphasize the need of accurate diagnosis of the aneurysms on the peripheral arteries, especially in women who frequently wear high heels and put their feet in the plantar extension, causing repeated long duration of low intensity traumas which can lead to aneurysmal degeneration with secondary atherosclerotic changes.

Keywords

patent foramen ovale, peripheral arterial aneurysm, pulmonary embolism

DOI

Literature

1. Ali Kausar Rushdi Y, Hina H, Patel B, Cross FW. The incidence of peripheral arterial embolism in association with a patent foramen ovale (right-to-left shunt). JRSM Short Rep. 2011 May;2(5):35. https://doi.org/10.1258/shorts.2011.0100742
2. Sonntag M, Hopper N, Graham AR. “Sandal strap” trauma and atherosclerosis are dual pathologies leading to bilateral true aneurysms of the dorsalis pedis arteries. J Vasc Surg. 2013 May;57(5):1391–4. https://doi.org/10.1016/j.jvs.2012.09.066