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PubMed1998

Cystic adventitial disease of the popliteal artery: diagnosis and treatment.

PURPOSE: This paper represents the presentation of a case of cystic adventitial disease of the popliteal artery and an exhaustive review of the literature with an emphasis on optimal means for diagnosis and treatment of this unusual disease. METHODS: We collect all reported cases of cystic adventitial disease of the popliteal artery since the last review in 1987 with an additional review of these cases reported in the U.S. since the initial description of the disease. RESULTS: We found 264 cases of cystic adventitial disease (CAD) of the popliteal artery from 1954 to 1995, with 38 reported in the U.S. Fifty-eight new cases of CAD have been reported since the last review in 1987; 11 of these were reported in the U.S. Diagnosis of the disease has improved in the last few years with non-invasive techniques. Duplex color scanning followed by T2-weighted MRI now appears to be the best diagnostic choice. Various therapeutic methods have been described for the treatment of CAD. The recommended treatments are excision of the cyst with the cystic wall when the artery is stenotic and resection of the affected artery, followed by an interposition graft, when the artery is occluded. CONCLUSION: Claudication in young, healthy patients resulting from popliteal artery stenosis or occlusion is a leading symptom of CAD. This disease affects males in a ratio of approximately 5:1 and appears predominantly in the fourth and fifth decades. The incidence is approximately 1 in 1200 cases of claudication or 1 in 1000 peripheral arteriograms. The predominance of reported cases is found in Japan and Europe. Optimal diagnostic techniques include duplex color scanning and T2-weighted MRI. The lesions can be effectively treated by resectional or non-resectional means depending on the presence or absence of complete arterial occlusion.

Adult↗
PubMed2005

Pseudoaneurysm of the popliteal artery. Surgical management of 3 cases.

Pseudoaneurysm of the popliteal artery is much less common than true aneurysm in this location. We report 3 cases of popliteal artery pseudoaneurysms, each of differing etiopathology, one presenting 3 months after trauma, one following aortic valve replacement for aortic regurgitation with suspected endocarditis, with no organism detected, and the 3rd of infective etiology. The clinical presentation and surgical management are discussed with a review of the literature.

Adult↗
PubMed1992

Axillary-popliteal artery bypass provides successful limb salvage after removal of infected aortofemoral grafts.

Axillary-popliteal artery bypasses were placed to revascularize 28 extremities for 17 patients who were undergoing removal of infected aortofemoral grafts. Polytetrafluoroethylene (PTFE [polytef]) material was anastomosed to the above-knee popliteal artery in 22 cases and to the below-knee popliteal artery in six limbs. All but one patient had axillary-popliteal grafts in place before excision of the aortic graft. In 12 groins, vein-patch angioplasty was performed after removal of the infected aortic graft to provide retrograde pelvic perfusion and maintain femoral patency for future reconstruction. Three patients (18%) died of septic-related, multisystem organ failure. With a mean follow-up of 25 months, primary patency was 75% at 1 year and 43% at 2 years. Secondary patency, maintained by thrombectomy (n = 7), revision (n = 3), and conversion to warfarin sodium (Coumadin) therapy (n = 6) was 100% at 2 years, and limb salvage was achieved for all surviving patients.

Anastomosis, Surgical↗
PubMed1999

Spontaneous popliteal artery dissection: a case report and review of the literature.

Spontaneous arterial dissection of a peripheral artery involving an extremity is a rare event. We report a case of atraumatic, nonaneurysmal dissection of the popliteal artery that occurred in a 62-year-old man who was admitted with progressive right lower-extremity claudication. Preoperative arteriography was suggestive of arterial dissection, and surgical treatment was undertaken before irreversible ischemia developed. Intraoperatively, a dissection of the popliteal artery was observed, and the patient underwent femoral-popliteal bypass grafting with the ipsilateral, greater saphenous vein and the popliteal artery was ligated distal to the dissection. Spontaneous dissection limited to the popliteal artery has not previously been reported in the literature. Successful management depends on consideration of the diagnosis, particularly when other, more common diseases have been excluded.

Humans↗
PubMed1984

Cystic adventitial disease of the popliteal artery.

Cystic adventitial disease of the popliteal artery is a rare but well recognized cause of arterial occlusive changes producing disabling symptoms in young patients. We have described a 37-year-old long-distance runner who noticed progressive decrease in the function of his right leg over a period of several months. The presence of an arterial occlusive lesion was difficult to define on clinical grounds, but was confirmed with noninvasive vascular studies and angiography. Surgical treatment by resection of the diseased segment and end-to-end saphenous vein interposition graft yielded excellent results.

Adult↗
PubMed1998

Surgery for giant popliteal artery aneurysm with a modified Sims' position.

A 73-year-old man with a giant popliteal artery aneurysm extending from the mid-thigh to the popliteal fossa underwent exclusion, bypass, and obliterative endoaneurysmorrhaphy while in a modified Sims' position. The use of this position allowed for exposure of the saphenous vein and the entire popliteal artery in the same operative field. No muscle division was required. Moreover, this position provided easy access to the superficial femoral and distal below-knee popliteal arteries.

Aged↗
PubMed2006

Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal.

This study defines the sagittal distance from the posterior cruciate ligament (PCL) to the popliteal artery under simulated arthroscopic conditions. This information is relevant for posterior knee arthroscopy, particularly for the safe establishment of the posterior trans-septal portal. Measurements from the PCL to the popliteal artery were made on sagittal magnetic resonance images obtained in a previous study of 10 fresh-frozen cadaveric knees. The mean sagittal distance from the mid-PCL to the popliteal artery was 29.1 +/- 11 mm (range: 18-55 mm). The mean sagittal distance from the proximal PCL fovea to the popliteal artery was 9.7 +/- 5 mm (range: 3-16 mm). The results of this study provide the arthroscopist working in the posterior compartments of the knee with a more detailed knowledge of the anatomic relationship between the PCL and popliteal artery. This knowledge will help minimize the risk of iatrogenic vascular injury during arthroscopic knee surgery.

Aged↗
PubMed1984

Aneurysms of the popliteal artery.

A retrospective study of 13 patients with 18 popliteal artery aneurysms has been undertaken. The patients were seen under a period of 12 years. Six of the patients had extrapopliteal aneurysms as well. Seven of the popliteal aneurysms presented as vascular emergencies, due to occlusion of the popliteal artery. In this group the amputation rate was 57%. In the elective group no amputation was necessary nor did any patient suffer from claudication during follow-up. Ultrasonography is a good tool for demonstrating the nature of the disease. Usually a short exclusion bypass is enough to reconstruct the area. A popliteal aneurysm, if not occluded and asymptomatic, is an indication to operate because of the threat to the limb in case of embolism or thrombosis.

Adult↗
PubMed1994

[Two cases of cystic adventitial disease of the popliteal artery. Current diagnostic approach].

The authors report two cases of cystic adventitial disease of the popliteal artery. Both patients complained of calf claudication and presented a thrombosis of the popliteal artery. In one case, magnetic resonance imaging exhibited a specific preoperative diagnosis. In both cases, at least one communication between the cysts and the capsule of the knee joint was demonstrated, supporting the congenital hypothesis of the disease. The two cases have been treated by vein graft replacement of the occluded popliteal arteries. Both patients have remained asymptomatic and the two grafts have remained patent during the ninth and twelfth month follow-up periods.

Adult↗
PubMed1997

Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves limb salvage.

OBJECTIVE: This study was conducted to evaluate those factors associated with popliteal artery injury that influence amputation, with emphasis placed on those that the surgeon can control. SUMMARY BACKGROUND DATA: Generally accepted factors impacting amputation after popliteal artery injury include blunt trauma, prolonged ischemic times, musculoskeletal injuries, and venous disruption. Amputation ultimately results from microvascular thrombosis and subsequent tissue necrosis, predisposed by the paucity of collaterals around the knee. METHODS: Patients with popliteal artery injuries over the 10-year period ending November 1995 were identified from the trauma registry. Preoperative (demographics, mechanism and severity of injury, vascular examination, ischemic times) and operative (methods of arterial repair, venous repair-ligation, anticoagulation-thrombolytic therapy, fasciotomy) variables were studied. Severity of extremity injury was quantitated by the Mangled Extremity Severity Score (MESS). Amputations were classified as primary (no attempt at vascular repair) or secondary (after vascular repair). After univariate analysis, logistic regression analysis was performed to identify the independent risk factors for limb loss. RESULTS: One hundred two patients were identified; 88 (86%) were males and 14 (14%) were females. Forty injuries resulted from blunt and 62 from penetrating trauma. There were 25 amputations (25%; 11 primary and 14 secondary). Patients with totally ischemic extremities (no palpable or Doppler pulse) more likely were to be amputated (31% vs. 13%; p < 0.04). All requiring primary amputations had severe soft tissue injury and three had posterior tibial nerve transection; the average MESS was 7.6. Logistic regression analysis identified independent factors associated with secondary amputation: blunt injury (p = 0.06), vein injury (p = 0.06), MESS (p = 0.0001), heparin-urokinase therapy (p = 0.05). There were no complications with either heparin or urokinase. CONCLUSIONS: Minimizing ischemia is an important factor in maximizing limb salvage. Severity of limb injury, as measured by the MESS, is highly predictive of amputation. Intraoperative use of systemic heparin or local urokinase or both was the only directly controllable factor associated with limb salvage. The authors recommend the use of these agents to maximize limb salvage in association with repair of popliteal artery injuries.

Adolescent↗
PubMed1979

Management of popliteal artery injuries.

In a series of seven popliteal artery injuries including two concomitant popliteal vein injuries and three knee dislocations, only one failure occurred. With appropriate training of emergency medical technicians and adequate supportive services such as blood banking and arteriography, the vascular surgeon in a small hospital setting can manage peripheral vascular trauma with acceptable results.

Colorado↗
PubMed2003

Bilateral popliteal artery aneurysms with rupture and pseudoaneurysm formation on the left.

The rupture of a popliteal artery aneurysm is very rare, and can lead to serious complications if untreated. Any reports of a huge pseudoaneurysm, following rupture of the popliteal artery aneurysm could not be found in a review of the literature. A pulsatile huge mass leading to a deep venous thrombosis, was observed in a 74 years old male patient who for 2 months had had a progressively swollen and painful left leg. On angiographic evaluation, the mass was found to be a pseudoaneurysm originating from a ruptured true aneurysm of the popliteal artery. There was also a small true aneurysm in the contralateral extremity at the same localization. Both the false, and true aneurysms were resected surgically and arterial continuity was established with a synthetic polytetrafluoroethylene graft.

Aged↗
PubMed2004

Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair.

OBJECTIVE: The purpose of this study was to assess and compare outcomes of elective versus emergent operative repair of popliteal artery aneurysms. DESIGN: A retrospective analysis of a prospectively recorded vascular surgery database from June 1992 to December 2002 was performed with chart review. Main outcome measures Patient survival, limb salvage, and graft patency were evaluated. RESULTS: Fifty-one popliteal artery aneurysms were repaired in 39 patients, all male and ranging in age from 18 to 87 years (mean 67.1). Mean follow-up was 47.8 months. Repair was elective in 37 (72.5%) and emergent in 14 (27.5%) limbs, 13 with acute ischemia and one with aneurysm rupture. Thrombolytic therapy was utilized in four ischemic limbs with no suitable bypass target vessel identified on initial arteriogram. Outflow vessels included the popliteal artery in 22 (43.1%) and infrapopliteal vessels in 29 (56.9%) limbs. Cardiac morbidity and 30-day mortality rates were 0%. Overall primary patency, secondary patency, limb salvage, and actuarial survival were 95.6%, 100%, 98.0%, and 98.0% at 1 year and 85.1%, 96.9%, 98.0%, and 83.8% at 5 years, respectively. Bypass graft redo or revision was performed for stenosis in one and occlusion in four limbs. Two amputations were performed at 6 days and 63.6 months after initial aneurysm repair. No difference was noted between elective and emergent groups with regard to patency, limb salvage, or survival (P >.26), and no association between the number of identified target vessels and limb salvage or patency was demonstrated (P =.12). CONCLUSION: In our experience, the outcome of the popliteal artery aneurysm repair was comparable in the emergent and elective settings. Aggressive tibial reconstruction plays a crucial role in the treatment of popliteal artery aneurysms, especially in those presenting with acute limb ischemia. Thrombolytic therapy is infrequently required in the acute setting, although it may be useful in patients with no identifiable outflow target vessel on initial arteriogram.

Adolescent↗
PubMed1995

The incidence of iliac, femoral, and popliteal artery aneurysms in hospitalized patients.

PURPOSE: Previous studies have attempted to determine the incidence and mortality rate of abdominal aortic aneurysms in a variety of populations; however, the incidence of iliac, femoral, and popliteal artery aneurysms have not been established. The objective of this study was to determine the incidence of lower extremity aneurysms in hospitalized patients in the state of Utah, which has a population at low risk for cardiovascular disease, atherosclerosis, and smoking, and to compare the results with the incidence in the United States. METHODS: Incidences of iliac, femoral, and popliteal artery aneurysm in Utah were determined over a 6-year period, with data obtained via diagnostic codes from the Utah Hospital Association. The incidence of iliac, femoral, and popliteal artery aneurysms in the United States hospital population was calculated by use of National Hospital Discharge Summary 1990 data, a complex sample of nonfederal short-stay hospitals in the United States, which provides the most comprehensive database of health statistics in the United States. RESULTS: The incidence of iliac femoral/popliteal artery aneurysms in hospitalized Utah men is 3.76 and 4.85 per 100,000 population, respectively. In American men, iliac and femoral/popliteal artery aneurysm incidences are 6.58 and 7.39 per 100,000 population, respectively. Incidences among hospitalized women in Utah are 0.24 and 1.07 per 100,000; incidences in women in the United States are 0.26 and 1.00 per 100,000, respectively. The incidence of nonaortic peripheral aneurysms among hospitalized patients in Utah is lower than in the United States. The rate ratios (Utah/United States) for incidences of iliac, femoral, and popliteal artery aneurysms in men are 0.57 and 0.66, respectively (p < 0.05). No statistical difference is seen between incidences in women in Utah and the United States (p > 0.05)-ratios of 0.93 and 1.06, respectively. CONCLUSION: This study validates the traditional belief that iliac, femoral, and popliteal artery aneurysms are much less frequent, at least in hospitalized patients, than previously published incidences of abdominal aortic aneurysms.

Adult↗
PubMed1995

A new therapeutic approach to popliteal artery entrapment syndrome (PAES).

OBJECTIVES: An alternative therapeutic approach to popliteal artery entrapment syndrome (PAES) with vascular complications. MATERIALS: Three male patients (16, 42 and 68 years) with thrombotic and/or embolic obstructions of popliteal or crural vessels as a consequence of popliteal entrapment syndrome. METHODS: Combined catheter treatment consisting of percutaneous transluminal thrombembolectomy (PTEE), local thrombolysis (LTL) and percutaneous transluminal dilatation (PTA) was performed for thrombotic and embolic obstructions of popliteal or crural vessels. The aberrant tendomuscular structures were surgically corrected at a later date. RESULTS: After the procedure systolic ankle/arm pressure ratios in the three patients improved from 0.66 to 1.13, 0.57 to 1.07 and 0.46 to 1.10. Twelve, 8 and 4 months later the patients were asymptomatic. None of the patients showed popliteal artery compression during plantar flexion on Duplex scanning. CONCLUSIONS: This new therapeutic approach avoids direct vascular surgery with bypass or patch implantation in patients with PAES who are often young. The long term results remain to be evaluated.

Adolescent↗
PubMedDate not supplied

Popliteal artery entrapment syndrome.

Three cases of popliteal artery entrapment syndrome, one of them bilateral, are presented with a review of the literature, with special reference to the embryological development of the popliteal space and the diagnostic and therapeutic problems presented by this syndrome.

Adolescent↗