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PubMed2002

Puncture of the popliteal artery using a Doppler-equipped (SMART) needle in transpopliteal interventions.

The puncture of the popliteal artery for percutaneous intervention is usually performed under fluoroscopic guidance or with the assistance of percutaneous ultrasound to avoid accidental arteriovenous fistulas. We present our experience in 119 cases with the use of a Doppler ultrasound equipped Seldinger needle (SMART needle) for the detection and puncture of the popliteal artery. In 119 interventions in 103 patients, the puncture of the popliteal artery was performed with the SMART needle. The puncture was successful in 94.1% (112 of 119) of cases. Six (5.2%) complications occurred during puncture: four hematomas (no therapy required) and two arteriovenous fistulas (treated by manual compression solely). The subsequent 112 interventions in 103 patients [98 percutaneous transluminal angioplasty (PTA), 8 PTA with stent implantations, 4 PTA with thrombolysis, 2 thrombolyses] were technically successful in 79.5% (89 of 112). The SMART-needle-guided popliteal puncture showed to be safe, fast, and easy to perform, which allowed the use of this technique by radiologists in training. The rates of success and complications are comparable to reported results for other visualization techniques, whereas time, effort, and training required are lower. This may contribute to a more widespread use of the transpopliteal access for interventions and therefore offers a therapeutic option in addition to vascular surgery.

Angioplasty, Balloon↗

PubMed2003

Popliteal artery entrapment syndrome.

Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.

Constriction, Pathologic↗

PubMed2006

Contemporary endovascular treatment for disease of the superficial femoral and popliteal arteries: an integrated device-based strategy.

Endovascular therapy for disease of the superficial femoral artery (SFA) and the popliteal artery remains controversial. Percutaneous treatment of this arterial segment presents a particular technical challenge, as the extent of disease varies from short, focal, and stenotic to long, diffuse, and occluded lesions. Over the last 2 decades, multiple therapies have been evaluated, including simple balloon angioplasty, directional atherectomy, stenting (both balloon-expandable and self-expanding), and more recently, intra-arterial radiation, laser, and cryotherapy. Regardless of which modality is used, however, endovascular therapy as a revascularization strategy has the potential to improve symptoms and quality of life and, in selected patients, to avoid limb amputation. While percutaneous endovascular treatment has been historically associated with high procedural success and favorable short and intermediate-term patency rates, long-term clinical results have proven disappointing. Conventional balloon angioplasty is limited by elastic recoil, dissection, and restenosis. Balloon-expandable stents (particularly in the distal SFA) are associated with late stent deformation and mechanical compression, with resultant late clinical failure. Newer self-expanding stents have shown improved initial results but have been limited by late mechanical fatigue and associated restenosis. With the development of several newer endovascular techniques in recent years, the possibilities for treating this condition have increased dramatically. Currently, no long-term comparative data exist regarding the role of these alternative technologies. This article summarizes and compares important data about new endovascular options for intervention therapy in SFA and popliteal disease. In addition, based on this analysis, we propose a contemporary treatment strategy, integrating older and newer technologies into a real-world algorithm.

Algorithms↗

PubMed1987

Lateral approach to the popliteal artery.

Techniques for exposure of the popliteal artery via lateral approaches above and below the knee are described. These techniques were used successfully in 21 patients who required secondary arterial reconstructions in the presence of extensive scarring, infection, or both in the standard medial access routes.

Aneurysm↗

PubMed1995

Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation.

PURPOSE: The role of arterial stenting in the treatment of femoral and popliteal arterial disease is controversial and has been hampered by recommendations for patients to be given anticoagulants (oral warfarin) for several months or more. This study was undertaken to evaluate the immediate and midterm outcomes of vascular stents implanted percutaneously in the femoral and popliteal arteries, without long-term anticoagulation. METHODS: Over a 3-year period, 32 patients admitted to a vascular surgery service had arterial stents implanted in the femoral (n = 22) or popliteal (n = 10) artery for the following indications: recurrent stenosis after angioplasty (n = 13), suboptimal result after angioplasty of occluded (n = 12) or calcified stenotic arteries (n = 2), percutaneous transluminal angioplasty-induced thrombosis or dissection (n = 5). Access to the artery was gained by percutaneous insertion of a hemostatic sheath into the ipsilateral common femoral artery. Systemic heparin was given at the time of stent insertion, and patients were prescribed daily low-dose aspirin. RESULTS: Successful stent implantation was achieved in 31 of the 32 patients. Acute thrombosis (< 30 days) occurred in two patients. There was no incidence of false aneurysm formation, acute leg ischemia, or vessel perforation. All patients were monitored by Doppler scanning index and duplex scanning within 24 hours, and thereafter at 3- to 6-month intervals. The mean ankle-brachial systolic pressure index improved from 0.60 (before treatment) to 0.88 (3 to 6 months after stenting). Stent occlusion has occurred in six patients; two stents were successfully salvaged with urokinase infusion. In follow-up to date (range 3 to 33 months) the primary patency rate by life-table analysis was 75% at 18 months, whereas the secondary patency rate was 89% at the same interval. Restenosis (> 50% lumen diameter) was detected by duplex ultrasonography in seven of 25 patent stents (28%) at a mean interval of 9.5 months (range 4 to 15 months); of these, four patients remained clinically symptom-free despite the ultrasound findings. CONCLUSIONS: We conclude that vascular stents can be implanted into the femoropopliteal arteries with few complications and with acceptable early and intermediate patency rates, without the need for long-term anticoagulation. Restenosis is not prevented by stents, and the main value of stenting at this site appears to be in salvaging acute complications of percutaneous transluminal angioplasty, or to correct suboptimal results after recanalization of occluded arteries.

Aged↗

PubMed1998

Mycotic aneurysm of the popliteal artery secondary to tuberculosis. A case report and review of the literature.

Mycotic aneurysms of the popliteal artery are rare; 33 cases have been reported in the literature. The treatment of choice is a large excision with extra-anatomic revascularization. In situ revascularization is sometimes possible. To the best of our knowledge, tuberculosis has never been reported as a causal factor of mycotic aneurysms of the popliteal artery. We report a case of a recurrent tuberculous false aneurysm of the popliteal artery. After 2 attempts at in situ revascularization, the femoral artery was ligated with no distal ischemia.

Adult↗

PubMed1990

Cystic adventitial disease of the popliteal artery.

Cystic adventitial disease of the popliteal artery is a rare and benign disease. The appearance of claudication in a young non-smoking male and the typical angiographic findings usually confirm the pathology.

Acute Disease↗

PubMed1988

Popliteal artery injury complicating arthroscopic menisectomy.

Inadvertent popliteal artery injury during arthroscopic menisectomy is an unusual occurrence. Prompt diagnosis and treatment are essential to achieve a good outcome, as illustrated in two of the five patients described herein. Pitfalls in diagnosis led to late recognition and therapy in three patients, with subsequent serious complications; namely, arteriovenous fistula, false aneurysm, and amputation. On the basis of this limited but poignant experience, we propose an outline of steps in management to help others avoid similar problems. If popliteal injury is suspected, we advise exploration immediately to avoid a potential limb-loss crisis. Heparin should be given as soon as diagnosis is made. A posterior incision in the knee crease, rather than the conventional medial approach, gives expedient exposure for precise repair. We also advise passing a no. 3 thrombectomy catheter distally to rule out or retrieve any clot that may have embolized. A completion angiogram is also helpful. Compartment pressure may be measured, but if any doubt exists, a three-compartment fasciotomy should be performed.

Amputation, Surgical↗

PubMed1996

Bilateral popliteal artery injury from bumper crush injury.

Blunt trauma to the knee of sufficient force to result in knee dislocation or fracture is commonly associated with popliteal artery injury. The challenging problem of bilateral popliteal artery injury has been rarely reported. We describe a case of bilateral popliteal artery injury after bumper crush injury between two automobiles that illustrates a successful method of management. Expeditious revascularization with minimum ischemia time was obtained by using the posterior approach, rather than the conventional medial approach, allowing two surgical teams to work simultaneously.

Accidents, Traffic↗

PubMed1975

Surgical treatment of popliteal artery injuries.

Twenty-seven patients with injury to the popliteal artery and associated structures were operated on during the past 15 years. There was no operative or hospital deaths. The limb salvage rate was 56%; the amputation rate was 44%. Those patients with penetrating injuries were found to have a much better salvage rate (85%) than those with blunt trauma (29%). Preoperative arteriography and immediate repair of the popliteal artery by either end-to-end anastomosis or a vein graft is advocated for these patients. Popliteal vein injuries should be repaired when possible by lateral suture or end-to-end anastomosis. Fasciotomy is advocated on a selected basis.

Adolescent↗

PubMedDate not supplied

[Popliteal artery entrapment syndrome].

A case of popliteal artery entrapment is described in a 36 years-old woman who presented with intermittent claudication. Several aspects of this rare syndrome are reviewed: incidence, pathogenicity, physiopathology, diagnosis and treatment. A peculiar accent is stressed on the dynamic tests to be realised together with the general examination of patients presenting with this rare and consequently almost unrecognized entity.

Adult↗

PubMed2001

Popliteal artery trauma. A critical appraisal of an uncommon injury.

Although popliteal artery injuries are uncommon, the consequent lack of management protocols may contribute to an already high level of outcome morbidity. We critically reviewed all nine cases of popliteal artery trauma treated at our institution in the last 5 years. The main findings were that blunt trauma was predominant and most patients presented with severe signs of ischaemia. Long delays occurred between injury and treatment, mostly due to the tyranny of distance. Nevertheless, most patients were subjected to further delay whilst undergoing unnecessary formal angiography. Interposition vein graft using contralateral long saphenous vein was the predominant procedure for arterial injury. Most patients did not receive systemic anticoagulation or fasciotomy, and none received intra-operative thrombolysis. Our limb salvage rate was 7/9, although two of these had persistent neurological disability. We criticise our shortcomings in the light of the current literature.

Adolescent↗

PubMed1997

[Intraoperative lysis and neurostimulation as added therapy in surgery of popliteal artery aneurysm].

Additional therapy of symptomatic popliteal artery aneurysm includes intraoperative lysis for the treatment of the descending thrombosis and spinal cord stimulation for cases of chronic deterioration of the peripheral perfusion state. Between 1989 and 1996, we treated 50 patients with 55 symptomatic aneurysms using this concept, 18 of them as emergency cases. We reached a postoperative amputation rate of 12.7% and good long-term functional results in 34 of 37 patients.

Aged↗

PubMed1985

Cystic adventitial disease of the popliteal artery.

Cystic adventitial disease of the popliteal artery has been recognized as a cause of arterial stenosis and calf claudication for 30 years. It is reported infrequently and its etiology remains unknown. In addition, a peculiar geographic distribution of the reported cases of this disorder has been noted, with a majority of cases from Europe and Australasia. The authors report here a case from South Carolina in which a fibrous band may have contributed to compression during exercise. Noninvasive studies and angiographic studies were negative before exercise and positive after exercise. Current ideas of diagnosis, surgical treatment and possible etiology are presented.

Adult↗

PubMed2004

Flexions of the popliteal artery: dynamic angiography.

BACKGROUND: Stenting of popliteal artery (PA) with self-expandable stents is a therapeutic option in selected patients with arterial disease. Fractures of these stents may occur, and they are thought to be related to development of hinge points (HPs) secondary to knee flexion. However, it remains obscure how movements of the knee affect the morphology of the PA and where HPs occur. OBJECTIVE: To describe the morphologic changes of the PA during knee flexion and their relationship with bone structures using dynamic angiography (DA). PATIENTS AND METHODS: All DA procedures performed in our institution between February 2000 and July 2003 were reviewed. Dynamic angiography consisted of a static phase (during which the knee was bent at 100 degrees) and a dynamic phase (during which the leg was passively extended to total extension following opacification of the PA). RESULTS: Sixty-three PAs in 57 patients with arterial disease were evaluated. In 62 PAs (98.2%), presence of an HP was identified and the pre-HP and post-HP segments also were defined. HPs were never observed at the level of the knee joint line. We developed a geometric model to establish a relationship of proximity between a bone structure and the HP. The HP was the main and most acute angled curve observed during knee flexion. Accessory flexions (AFs) were observed when the knee was bent in 46 PAs (73%). Presence of AFs was associated with high blood pressure (p < 0.01). CONCLUSION: We identified HPs of the PA as the main curve observed during knee flexion as well as a large number of AFs. DA appears to be a useful diagnostic tool for obtaining the most accurate morphologic information about the PA during knee flexion.

Adult↗

PubMed2006

Spontaneous dissection of the popliteal artery in a young man. A rare cause of the blue toe syndrome.

Spontaneous arterial dissection in peripheral arteries of the extremities is an extremely rare event. We report a case of a spontaneous dissection of a nonaneurysmal popliteal artery in an otherwise healthy 36-year-old man that came to clinical attention as an acute blue toe syndrome. The diagnosis was primarily made by high-resolution duplex ultrasound that revealed a dissection flap (length: 15.5 mm; thickness: 0.4 mm) together with the partially thrombosed false lumen at the dorsal wall of the left popliteal artery (degree of local diameter reduction: 56%). Further work-up by means of contrast-enhanced MR-A and conventional DSA confirmed a moderate stenosis of the popliteal artery compatible with focal dissection and excluded other causes such as popliteal artery entrapment syndrome. Under full-dose intravenous anticoagulation with unfractionated heparin that was switched to oral anticoagulation with vitamin K antagonists (target INR: 2-3) and conservative management of the blue toe the patient made a gradual, but eventually complete clinical recovery over 8 weeks.

Adult↗

PubMedDate not supplied

[Sub-adventitial rupture of the popliteal artery and recurrent ischemia: a diagnostic pitfall in young patients].

In the absence of thromboembolic risk factors, signs of thrombosis in situ, or disorders of coagulation, two possible diagnoses must be envisaged when acute recurring ischemia is observed in a peripheral area of tissue: extrinsic compression or rupture of an arterial coat, especially when the subject is young and in good general health. The case of a 35 year old patient presenting with recurring ischemia in the popliteal artery of the right lower limb due to sub-adventitial rupture of the popliteal artery suggests three comments: the period of latency (3 months) between initial trauma to the popliteal artery and the operation of reverse saphenous vein bypass, the necessity for dynamic manipulations together with angiographic and ultrasound examination, the probable underestimation of the traumatic or functional causes of this disorder (popliteal artery), and the surgical prognosis remains excellent.

Adult↗

PubMed1982

The fate of bypass grafts to an isolated popliteal artery segment.

From 1967 to 1982, 55 patients underwent 64 femoropopliteal bypass grafts into an isolated popliteal artery segment. Seventy-six percent of these patients had threatened limb loss from advanced atherosclerosis, and 24% had disabling claudication. Forty-five percent of the patients were diabetic. The 30-day operative mortality rate was 1.6%, and the 30-day postoperative amputation rate was 3.2%. Graft potencies were analyzed by the life table method. The 2-year graft patency rate was 70.6%, and the 5-year patency was 60.7%. The 2- and 5-year limb salvage rates were each 83%. With evidence for decreased graft function, four grafts (6%) were successfully revised before failure occurred. Among 10 polytetrafluoroethylene grafts followed up to a maximum of 48 months, there was one early postoperative occlusion, one long-term occlusion, and one early amputation. With respect to patency and limb salvage, the results of isolated popliteal artery segment grafts fall between the 5-year patency and limb salvage rates for autogenous vein grafts to popliteal arteries with at least one tibial vessel runoff (78% patency and 89% limb salvage) and the rates for femoral-tibial/peroneal grafts (5-year patency 56%, limb salvage 69%). An isolated segment is an appropriate recipient vessel for a reconstruction for limb salvage, and reasonably good results can be anticipated.

Actuarial Analysis↗