Spontaneous Arterial Thrombus and Dissection Associated With Exercise and Exogenous Testosterone Use

Spontaneous lower extremity arterial dissection has been linked to atherosclerotic and non-atherosclerotic causes. A 55-year-old male presented to the emergency department via emergency medical services for a chief complaint of right leg pain. He stated that he was performing leg exercises when he felt a sudden pop in his right leg followed by severe pain. His exam was remarkable for lack of ipsilateral distal popliteal or dorsalis pedis pulse by palpation or doppler. The patient was admitted to a three-year history of non-prescription testosterone injection use along with a history of prior portal vein thrombosis two years prior with anticoagulation noncompliance after one month of therapy. A computed tomography angiography of the lower extremity was performed which demonstrated complete acute occlusion of the right common iliac, and right external iliac, along with right femoral artery dissection. The patient was emergently taken to the operating room with vascular surgery where a thrombectomy with stent placement was performed. After three days in the surgical intensive care unit and nine days in the hospital, the patient was subsequently discharged from the hospital in good condition. A post-operative follow-up appointment three weeks after discharge revealed mild residual pain; however, no issues ambulating or residual weakness, and normal ankle-brachial indexes. This case highlights a unique presentation of acute limb ischemia associated with exogenous testosterone use.