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At least 217 records · Page 12Linked to original sources
PubMed2004

Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified?

OBJECTIVE: Complete lower limb ischemia as a result of blunt popliteal artery injury is associated with the highest morbidity and amputation rates among all of the peripheral vascular injuries. The purpose of this study was to determine the possible benefits of routine use of a temporary intraluminal arterial shunt in patients with complete limb ischemia from blunt popliteal trauma. PATIENTS AND METHODS: Over 3 years seven blunt popliteal artery injuries with complete lower limb ischemia were managed with insertion of a shunt at the initial phase of the operation. Data from these procedures was analyzed and compared with retrospectively collected data for 10 injuries with complete ischemia treated without shunts during the preceding 5 years. RESULTS: Mean injury severity score and mangled extremity severity score were 9.3 +/- 3.49 and 5.7 +/- 0.95, respectively, in the shunt group, and 9.9 +/- 3.57 and 5.9 +/- 0.56, respectively in the non-shunt group. Mean ischemic time was 244.3, 24.3, and 268.6 minutes, respectively, for preoperative, intraoperative, and total ischemic time in the shunt group, and 273, 56.5, and 329.5 minutes in the non-shunt group. The difference was significant for intraoperative (P <.001) and total (P <.05) ischemic time. In the entire group, 92.8% of patients with total ischemic time greater than 4 hours underwent fasciotomy, 100% required repeat operation, and 57.1% had complications and required fasciotomy wound debridement. All patients (100%) with ischemic time greater than 6 hours required amputation, compared with no patients with ischemic time less than 5 hours. One patient in the shunt group (14.3%) experienced one fasciotomy wound complication (11.1%), compared with seven patients in the non-shunt group (70%) had 8 complications (88.9%) (P <.05). Mean number of repeat operations was 0.8 +/- 1.06 in the shunt group, and 1.9 +/- 0.73 in the non-shunt group (P <.05). One patient in the shunt group (14.3%) required fasciotomy wound debridement, compared with seven patients in the non-shunt group (70%; P <.05). Mean hospital stay was 14.4 and 23 days, respectively, in the shunt and non-shunt groups (P <.05). Four limbs in the non-shunt group (40%) required amputation, compared with 100% limb salvage in the shunt group. CONCLUSION: Temporary arterial shunting after blunt lower limb trauma significantly reduces total ischemic time, complications, repeat operations, amputation, and hospitalization. I recommend routine use of shunts in blunt popliteal artery injuries with complete lower limb ischemia.

Adolescent↗
PubMed2006

Endovascular repair of popliteal artery aneurysms: techniques, current evidence and recent experience.

Endovascular repair of popliteal artery aneurysms is a new technique, which has emerged as an alternative to open surgical bypass. However, evidence to support its use is limited. We present a review of current literature relevant to this technique. The MEDLINE search terms were popliteal artery, aneurysm, endovascular, endoluminal and stent. Fifty-eight articles were yielded, of which 21 were studies of endovascular repair by implantation of stent or stent graft of true aneurysms of the popliteal artery. There was only one randomized study. Small numbers of endovascular interventions are reported, with variations in study design and endovascular techniques. Long-term follow-up data is lacking; however, early results have been promising with high rates of initial treatment success. Early thrombosis of stent grafts occurs in approximately 10%, but this does not herald limb loss. Endovascular treatment offers potential benefits over traditional surgery, but needs to be studied further with a large-scale multicentre randomized trial.

Aneurysm↗
PubMed1994

Popliteal artery injury in a lumberjack.

We discuss the case of a patient with knee dislocation and popliteal artery injury. A high index of suspicion for vascular injury must be maintained in cases of blunt knee injury because more than one third of patients with knee dislocation will have an associated popliteal artery injury. Patients with a grossly unstable knee after blunt trauma often have had a knee dislocation; such patients should receive aggressive evaluation for popliteal artery injury. Arteriography should be done for all trauma patients with a grossly unstable knee joint or knee dislocation and palpable pedal pulses. For patients with severe limb ischemia, arteriograms may be done in the operating room to expedite revascularization. Without rapid recognition and revascularization, blunt injury to the popliteal artery results in a rate of limb loss of more than 30%.

Accidents, Occupational↗
PubMed1984

A comparison of nuclear magnetic resonance and intravenous xeroangiography with conventional arteriography in popliteal artery imaging.

Twenty-nine patients with peripheral vascular disease had the popliteal artery segment assessed by xeroangiography and nuclear magnetic resonance (NMR) scanning. The result of each test was compared with conventional contrast arteriography. Nuclear magnetic resonance and xeroangiography correctly predicted popliteal artery patency in 97% and 100% of limbs, respectively, and occlusion was correctly predicted in 44% and 63% of limbs. The ability of xeroangiography to define the state of the popliteal artery accurately makes this a useful method in high-risk patients. The potential for NMR imaging appears very promising but more work is required to define its future clinical application.

Adult↗
PubMed2004

[Popliteal artery aneurysms from a vascular surgeon's point of view].

Popliteal artery aneurysms (PAA) are a dangerous complication of general atherosclerosis or other diseases. PAAs with a diameter of less than 2 cm are observed despite the fact that small aneurysms may also result in peripheral embolism. The spectrum of complications in the course of the disease ranges from multiple embolism into the crural arteries or complete thrombosis of the popliteal artery associated with complete ischaemia. Rupture is rare even in large aneurysms. Interventional therapy using covered stents does not lead to results comparable with surgery and is not considered as standard therapy. Surgical technique in asymptomatic aneurysms includes resection/exclusion of the PAA with reversed vein PI-PIII vein bypass. In case of acute ischaemia the therapy has to be modified according to anatomic aspects and has to be combined in some cases with intraoperative lysis. Amputation rate may be as high as 40%. Large aneurysms (>3 cm) should be treated by aneurysmorrhaphy or resection with graft interposition rather than simple bypass. In our study with short follow-up only 3 of 10 patients were asymptomatic. Survival rate, limb salvage and patency amounted to 100%.

Aged↗
PubMed2003

[Surgical strategy in traumatic lesions of the popliteal artery].

An examination and treatment of 32 patients with injured popliteal arteries are analyzed. Among the etiological factors there were gunshot wounds (16), crushed (4), punctured-incised (7) and blunt (7) traumas. Combined injuries of the popliteal vein were diagnosed in 12 patients, and injuries of the bones--in 16 patients. Errors were made in 19 cases at the prehospital stage: late diagnosis of the injury (11), transporting the patient in the state of shock (5), ligation of the popliteal artery (3). The term of extremity ischemia more than 8 hours was noted in 13 admitted patients. Decompensation of circulation was diagnosed in 22 patients. The primary amputation was performed on 6 patients with moist gangrene. Vascular reconstructions were made in 26 cases including the autovenous prosthesis and circular suture. Secondary amputations were fulfilled to 6 patients. Three patients died. Good results were obtained in 20 cases.

Adolescent↗
PubMed1982

Fibrodysplasia of the popliteal arteries.

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.

Aged↗
PubMed2001

Examination of the apoptotic pathway and proteolysis in the pathogenesis of popliteal artery aneurysms.

OBJECTIVES: to investigate the role of apoptosis, expression of death-promoting molecules and mediators of apoptosis in the development of popliteal artery aneurysms. METHODS: ten popliteal artery aneurysm (PAA) specimens were obtained from patients undergoing elective surgical repair. Normal controls were popliteal arteries obtained from patients without PAA undergoing infrainguinal bypass surgery (n=8). Standard histochemistry techniques were used to assess elastic lamellae fragmentation and inflammatory infiltrate in PAA. Vascular smooth muscle cells (VSMC), macrophages, T lymphocytes, death-promoting molecules, CPP-32, Fas, p53, perforin, apoptosis-mediating Bcl-2 family proteins and apoptotic death substrate, poly(ADP-ribose) polymerase (PARP) were detected immunohistochemically. Detection of apoptosis was by TUNEL assay. Proteolytic activity was determined by 10% gelatin gel zymography. RESULTS: there is a conspicuous disruption and fragmentation of elastic lamellae in PAA as compared to normal arteries. Increased gelatinolytic activity was observed at 92, 84, 72 and 67 kDa in PAA tissues. There is a significant decrease of VSMCs in the PAA walls (p=0.02). The control arteries had fewer CD68+ macrophages and CD3+ T cells in their media (p<0.01). There was a significant increase in the number of cells undergoing apoptosis in aneurysmal tissue than in the normal vessels, (p<0.02) as well as an increased expression of Bax, CPP-32, Fas, p53 and perforin. CONCLUSIONS: the data confirm the architectural disruption of the PAA wall and illustrate an apparent biological response involving inflammatory infiltrate, apoptosis and signalling molecules capable of initiating cell death. In addition to compromising the mechanical integrity of the vessel wall, VSMC loss may contribute to imbalance in the protein profile, accelerating extracellular matrix degradation that could favour PAA development.

Aged↗
PubMedDate not supplied

Popliteal artery entrapment syndrome: accurate morphological diagnosis utilizing MRI.

A case of bilateral popliteal artery entrapment syndrome was accurately diagnosed utilizing magnetic resonance imaging (MRI) in a 34-year-old male with intermittent claudication. The abnormal structure was clearly visualized in relation to the popliteal artery in T1-weighted sagittal and axial sections of MRI. The type of entrapment was determined by this method prior to surgery. Intermittent claudication disappeared after surgical repair. Our experience emphasizes that MRI facilitates the accurate morphological diagnosis of popliteal artery entrapment syndrome.

Adult↗
PubMed2003

Cystic adventitial disease of the popliteal artery. Report of 1 case and review of the literature.

Cystic adventitial disease (CAD) of the popliteal artery is a rare but well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial and the literature reports various hypotheses for its origin. Diagnosis starts with thorough history taking and physical examination; non invasive diagnostic studies comprise color duplex scanner (ECD), computed tomography (CT), better if elicoidal (3D CT) and magnetic resonance imaging (MRI), which can aid in establishing correct recognition of the disease in most cases. A 48-year-old man presented with intermittent right calf claudication that had begun 4 months earlier; the symptom-free interval was about 100 m. MRI and MR angiography of right popliteal fossa revealed the presence of an oval cystic (maximum diameter 45 mm). The caudal aspect of the cyst showed pedicles protruding between the popliteal vein and the popliteal artery that compressed the artery, causing complete occlusion of its lumen. Surgery was performed through the posterior approach using an S-shaped incision; the affected segment of the popliteal artery was successfully excised and replaced with an autogenous external saphenous vein graft. A follow-up is underway, both clinical and with; no cyst recurrence has so far been detected either clinically or by duplex scanner during the 15-month postoperative follow-up period; the graft is patent and the patient is completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of adventitial cystic disease of the popliteal artery. Medical history, clinical examination and non invasive instrumental investigations, such as duplex scanner, elicoidal CT and/or MRI, may aid in establishing the correct diagnosis.

Humans↗
PubMed2002

Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study.

BACKGROUND: Knee dislocation, which poses a significant risk for injury of the popliteal artery, prompts many surgeons to evaluate these patients with arteriography routinely. Our hypothesis was that physical examination alone (without arteriography) accurately confirms or excludes surgically significant vascular injuries associated with knee dislocation. METHODS: All patients diagnosed with a knee dislocation by an attending orthopedic surgeon between January 1990 and January 2000 were prospectively managed by protocol at our Level I trauma center according to their physical examination. Those with hard signs (active hemorrhage, expanding hematoma, absent pulse, distal ischemia, bruit/thrill) underwent arteriography followed immediately by surgical repair if indicated. Patients with no hard signs (negative physical examination) were admitted for 23 hours, underwent serial physical examination, and then followed as outpatients. RESULTS: There were 35 knee dislocations in 35 patients during this 10-year period. The average age was 31 years; 18 dislocations were on the right knee and 17 were on the left. Two patients died from closed head injuries and multisystem trauma. Eight patients were found to have hard signs (positive physical examination) either at presentation (six patients) or during their hospitalization after reduction of their dislocation (two patients). All eight patients demonstrated a loss of pulses only. Six of these patients showed occlusion of the popliteal artery on arteriography and underwent surgical repair without complication (five vein grafts, one primary repair), one demonstrated spasm of the popliteal artery, and one showed a normal artery that required no treatment. None of the 27 patients with negative physical examination during their hospitalization ever developed limb ischemia, needed an operation for vascular injury, or experienced limb loss. Sixteen patients were available for follow-up (46%). Twelve patients with negative physical examination (44%) were contacted (mean, 13 months; range, 2-35 months), and four of the eight patients with positive physical examination (50%) and surgical repair were contacted (mean, 19 months; range, 6-49 months). None of the patients in either group developed any vascular-related symptoms or suffered from a vascular repair complication over the follow-up interval. CONCLUSION: This limited series suggests that the presence or absence of an injury of the popliteal artery after knee dislocation can be safely and reliably predicted, with a 94.3% positive predictive value and 100% negative predictive value. Arteriography appears to be unnecessary when physical examination is negative but may avert negative vascular exploration when physical examination is positive. This approach substantially reduces cost and resource use without adverse impact on the patient.

Angiography↗
PubMed2000

Treatment of popliteal arterial aneurysm using a superficial femoral artery autograft.

The usefulness of aggressive surgical management of popliteal arterial aneurysm is now widely accepted. Reconstruction is usually performed using either prosthesis or saphenous vein autograft. Autografts are preferable but not always possible because of problems of availability and congruence. An alternative conduit for cases involving lesions spanning the articular midline of the knee is the superficial femoral artery. From 1993 to 1998, we used superficial femoral artery autografts to treat a total of 18 aneurysms in 12 patients. All patients were male with a mean age of 66 years (range, 42 to 75). Fourteen aneurysms were treated during elective procedures, including four in combination with aortic repair. The remaining four were treated on an emergency basis. Exposure was achieved via the internal medial route in all cases. Treatment consisted of exclusion or aneurysmorraphy. The mean length of the autograft harvested from the ipsilateral thigh was 10.2 cm (range, 6-18). The harvested graft was replaced by a PTFE prosthesis. Our results show that superficial femoral artery autografts are a suitable alternative for two indications: for patients with small aneurysms located in the middle of the popliteal artery, since autografts provide excellent congruence, and for patients with no other useable donor vein or concurrent deep venous thrombosis.

Adult↗
PubMed1991

Popliteal artery entrapment: findings at MR imaging.

Magnetic resonance (MR) imaging can noninvasively demonstrate the anatomic relationships between the popliteal artery and the muscles within the popliteal fossa, making it an ideal screening test for popliteal artery entrapment prior to angiography or surgery. The authors describe a patient with bilateral type II popliteal artery entrapment in whom the anomaly was diagnosed in the asymptomatic extremity with MR imaging.

Adult↗
PubMed1991

Delayed presentation and treatment of popliteal artery embolism.

In the course of reviewing a 10-year experience with popliteal artery embolism (PAE), two distinct patterns of clinical presentation were identified. In addition to those patients presenting with typical acute (symptom duration less than 7 days) arterial ischemia, a second group was identified who presented with more chronic symptoms. The present study was conducted to contrast the clinical factors and treatment of these two temporal patterns of presentation with PAE. Sixty PAEs in 58 patients were documented by the combination of angiography and/or exploration of the popliteal artery. Acute presentation (AP) was seen in 41 (68%) of these and delayed presentation (DP) was noted in 19 (32%) patients. Delayed presentation patients typically presented with a history of sudden onset of claudication or rest pain and a median symptom duration of 30 days. Eighty per cent of AP patients presented with immediately threatened limbs. Angiography was generally diagnostic of chronic popliteal embolism. In the acute group, 90% were treated with embolectomy alone, while 20% of the DP group required bypass grafting. However in two thirds of the DP group, embolectomy alone performed through a direct popliteal approach was possible. Current results with overall limb salvage (92%) and mortality (7%) represents a substantial improvement compared to the authors' previous experience with PAE. The current study suggests that as many as one third of patients with popliteal artery embolism may present in delayed fashion with chronic symptoms. Furthermore most of these patients can be treated with direct popliteal embolectomy alone with favorable results.

Amputation, Surgical↗
PubMed2005

Diagnosis and surgical management of popliteal artery entrapment syndrome.

BACKGROUND: The purpose of the present study was to report the authors' experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10-year period. METHODS: From 1995 to 2004, six patients (eight limbs) underwent surgery for PAES at a single institution. The patients' data were collected retrospectively from the case records and operative notes. RESULTS: There were six patients with a mean age of 34 years (range, 27-38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days-9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated. CONCLUSION: Popliteal artery entrapment syndrome is a rare but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis and surgical intervention is imperative for good operative outcome and to prevent limb loss.

Adult↗
PubMed2005

[Difficulties in diagnosis of ruptured popliteal artery aneurysm].

Rupture is a very rare complication of popliteal artery aneurysm. In this paper a case of, originally misdiagnosed as an abscess, ruptured popliteal aneurysm in a 82-year-old man is presented. Main symptoms were pain and a mass in distal part of the thigh and in popliteal fossa and anaemia. After admission to our institution arteriography was performed and the patient was operated on as an emergency. The part of destroyed popliteal artery was reconstructed with the segment of autogenous great saphenous vein.

Aged, 80 and over↗
PubMed1988

Penetrating popliteal artery injuries in children.

Two children, aged 8 and 12, were seen recently at the Vanderbilt University Medical Center and Metropolitan Nashville General Hospital with gunshot injury to the popliteal artery. Both patients presented with late complications following missed penetrating injury to the popliteal artery. At presentation, distal pulses were palpable despite significant proximal arterial injury. Arteriography detailed traumatic popliteal artery aneurysms in both children, and an arteriovenous fistula in one child. These two children represent the youngest patients recorded in the surgical literature with gunshot trauma to the popliteal artery, subsequent formation of traumatic aneurysms, and an arteriovenous fistula. The increasing availability of guns and rifles in the household will likely increase the incidence of such injuries to children. As evidenced by these children, palpable pulses distal to an injury do not obviate the need for arteriography when arterial injury is suspected. Autogenous repair of the injured artery or reconstruction with autogenous vein graft is preferable for repair of vascular injuries in children.

Aneurysm↗