[Traumatic aneurysm of the femoral artery complicated by a thromboembolism of the popliteal artery].
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Cystic adventitial disease of the popliteal artery: a report of two cases and a review of the literature.
Cystic adventitial disease is a rare condition affecting the wall of certain major arteries. The case histories of two patients presenting to the Royal North Shore Hospital are reviewed. Both patients were young men who presented with unilateral incapacitating calf claudication of sudden onset. Lower limb arteriography on each affected leg revealed a peculiar irregularity of the popliteal artery. Each patient had the popliteal artery explored and similar findings were revealed viz: an extensive cyclic lesion occupying the adventitial layer of the popliteal artery. The cysts were found to contain mucoid material. It was not necessary to enter the arterial lumen in either case. As far as can be established both patients have remained asymptomatic after the simple procedure of evacuating mucoid material from the cysts.
Adult↗
Differential expression of YAMA/CPP-32 by T lymphocytes in popliteal artery aneurysm.
BACKGROUND: We have previously demonstrated that programmed cell death, proteolytic activity, and inflammatory infiltrate in the aneurysmal wall may have a role in the pathogenesis of popliteal artery aneurysms (PAA). This investigation examines the expression of a cell death-promoting molecule, a cysteine protease, YAMA/CPP-32 in a series of PAA specimens. METHODS: Twenty PAA specimens were obtained from patients undergoing elective surgical repair. Normal controls were popliteal arteries obtained from patients without PAA who were undergoing infrainguinal bypass surgery (n = 8). Standard histochemistry techniques were used to assess inflammatory infiltrates in PAA. Expression of apoptosis-promoting molecule, CPP-32, vascular smooth muscle cells (VSMC), macrophages, and T lymphocytes was detected by immunohistochemistry. RESULTS: There is a conspicuous disruption and fragmentation of elastic lamellae and increased inflammatory infiltrate in the PAA as compared with normal arteries. As compared with normal popliteal artery tissues, the PAA demonstrated large number of cells immunopositive for CPP-32 (60.45 +/- 4.25% P < 0.05). This study revealed significantly increased expression of CPP-32 in the T-cell population of the PAA as compared with the other cells (P < 0.01). Dual immunolabeling and investigation of serial sections demonstrated that co-expression of CPP-32 was maximum in the CD8+ subset (37 +/- 3.3% of the total CPP-32 immunoreactive cells identified). CONCLUSIONS: The data emphasize that the inflammatory infiltrate in the PAA walls has a significant role in the pathogenesis of this vascular disorder. Cells expressing death-promoting molecules are present in large numbers and are predominantly T lymphocytes in PAA. In addition to compromising the mechanical integrity of the vessel wall, apoptosis in the inflammatory infiltrate may contribute to the production of cytokines, activation of other signaling molecules such as stress proteins that could eventually favor PAA development.
Aged↗
Extended medial approach to the popliteal artery without muscular division.
This technique allows wide access to the entire popliteal artery by detaching the tendons of the pes anserinus and semimembranosus muscles, without any muscular division. The tendons are reinserted anatomically upon completion of the vascular procedure. This technique was used in 14 patients, without complication. This technique is of particular value when it is necessary to inspect the popliteal artery to determine the etiology of the occlusion in the young subject. It is invaluable when direct access to the midpopliteal artery is required.
Humans↗
Cystic adventitial disease of the popliteal artery--a case of young boy.
Cystic adventitial disease (CAD) of the popliteal artery (PA) is rare but one of the well-recognized causes of intermittent claudication. Now more than 200 case reports are available in the world, but there are only 6 cases younger than 15 years old. In this paper, we report a case of 14-year-old boy with CAD of the PA found by intermittent claudication. On examination, the pulses were not palpable below the right popliteal artery, and the angiography demonstrated about 1.5 cm-long obstruction of the right PA. We operated a resection of a cyst with artery, and replaced the autovein graft (V. saphena magna). Cyst contained mucoid degeneration-like ganglion. Two weeks after operation, the angiography showed no stenotic lesion, and follow-up at 4 years showed no symptoms.
Adolescent↗
The popliteal artery entrapment syndrome in children.
This article reviews 41 cases of the popliteal artery entrapment syndrome in individuals less than 20 years of age. In this syndrome, symptoms are caused by vascular insufficiency produced by either an anomalous course of the popliteal artery or anomalous muscles impinging upon it. Because vascular insufficiency is uncommon in orthopedic patients in this age group and this syndrome has received little attention in the orthopedic literature, orthopedists unfamiliar with this relatively easily diagnosed condition may miss it.
Adolescent↗
[The popliteal artery entrapment syndrome in an older patient. Its diagnosis after unsuccessful laser-assisted percutaneous transluminal angioplasty].
HISTORY AND FINDINGS: A 52-year-old patient complained of progressively increasing pain in his left leg when walking. The pain-free walking distance was 50-100 m. He was smoking about 20 cigarettes daily. No pulses were palpable in the left leg below the inguinal fossa. Recapillarisation time was normal in both legs and there were no trophic changes. INVESTIGATIONS: The Doppler perfusion pressure values were up to 40 mm Hg less in the left than the right leg. Ankle oscillography record showed a definite stenosis curve on the left. Digital subtraction angiography of the left leg showed a short occlusion of the popliteal artery with many collaterals and atypical medical deviation of the artery. The findings were interpreted as indicating peripheral arterial vascular disease. TREATMENT AND COURSE: Laser-assisted percutaneous transluminal angioplasty with balloon dilatation merely achieved a narrow lumen which again closed on plantar flexion of the left foot. The reversible occlusion suggested popliteal artery entrapment. At operation the popliteal artery coursed atypically over the dorsal medial aspect of the medial head of the gastrocnemius muscle. The arterial segment in the stenotic area was replaced by an autologous venous graft and the gastrocnemius muscle fixed laterally. The patients no longer experienced any impairment on walking and repeat angiography showed unimpeded flow through the graft even on plantar flexion. CONCLUSION: Popliteal artery entrapment is rare in the elderly and may be overlooked without provocation test and complete visualisation of the leg and pelvic arteries.
Angiography, Digital Subtraction↗
Successful endoluminal repair of a popliteal artery aneurysm using the Wallgraft endoprosthesis.
PURPOSE: To describe the first application of the Wallgraft endovascular prosthesis to aneurysm exclusion in the popliteal artery. METHODS AND RESULTS: A 61-year-old man was admitted to our institution with a popliteal artery aneurysm complicated by associated popliteal vein compression, deep venous thrombosis, and pulmonary embolism. The endovascular procedure was performed percutaneously with local anesthesia using a low-profile, covered stent (Wallgraft Endoprosthesis). The aneurysm was successfully excluded from the arterial circulation, and there were no postprocedural complications. Follow-up evaluation with appropriate imaging at 10 months revealed no endoleaks. CONCLUSIONS: This initial result indicates that percutaneous deployment of the Wallgraft endoprosthesis, with its smaller diameter and flexible design, may offer significant advantages over currently available devices for repair of popliteal artery aneurysms. This method obviates the need for general anesthesia or surgical exposure, which is particularly beneficial in patients with comorbid illnesses.
Aneurysm↗
Gray scale ultrasound evaluation of popliteal artery aneurysms.
GRAY SCALE B-scan ultrasonography is accurate in identifying and assessing morphologic features of popliteal artery aneurysms. Eight patients with suspected popliteal aneurysms had 12 aneurysms demonstrated by ultrasonography, including two not visualized by arteriography due to proximal occlusive disease and three covert aneurysms opposite a contralateral palpable popliteal mass. Half the patients had bilateral aneurysms demonstrated by ultrasonography. Popliteal artery ultrasonography is useful to: (1) evaluate suspected aneurysms in patients who cannot or should not be subjected to invasive arteriographic studies or operation; (2) confirm or refute equivocal diagnoses of aneurysms generated by arteriographic studies or physical examination; (3) detect contralateral clinically covert aneurysms or small aneurysms in patients with generalized extrapopliteal aneurysmal diseases; (4) delineate the extent of intraaneurysmal thrombus and determine exact aneurysm size in all dimensions; and (5) define a thrombosed aneurysm or one noe opacified because of limited contrast material passing through proximally obstructed arteries. The latter two uses of ultrasonography represent significant advantages over arteriography.
Aged↗
[Adventicial cyst of the popliteal artery].
In a 42-year-old man with intermittent calf claudication, cystic adventitial disease of the popliteal artery was demonstrated by 3D CT. Cystic mass was seen to be compressing the arterial lumen. The diagnosis of cystic adventitial was confirmed by surgery. Compared with color doppler sonography, MR Imaging, 3D CT provides additional useful anatomic information concerning disease of the popliteal artery, usually gained only with sonography or arteriography.
Adult↗
False aneurysm of the popliteal artery treated successfully by surgery: report of two cases.
Blunt trauma to the popliteal artery may result in pseudoaneurysm formation. We herein report two patients who had a pseudoaneurysm of the popliteal arteries without any orthopedic injuries. One patient, who had been struck by an iron plate in the midthigh portion, demonstrated a pulsatile mass in this area 2 months later. The other patient had a pseudoaneurysm that was diagnosed by a histological examination; however, he could not remember having suffered any noticeable trauma.
Aged↗
Diagnosis of popliteal artery entrapment syndrome: the role of duplex scanning.
The authors present a new diagnostic procedure to quickly and noninvasively diagnose the popliteal artery entrapment syndrome. A large personal experience on the surgical treatment of such a disease (29 cases in 22 patients) allowed us to focus on the optimal diagnostic procedure useful to detect this problem at an early stage. The technique is based on continuous-wave Doppler and duplex scanning studies done both in the resting state and during active contraction of the calf muscles. If compression of the popliteal artery occurs with contraction of the calf muscles, it will be detected by a decrease in flow. This finding will also direct the radiologist to obtain films when the maneuver is repeated. This makes it unlikely that the diagnosis will be missed. Since July 1988 a total of 1212 patients were evaluated with continuous-wave Doppler for suspected chronic ischemia. From this group 41 patients were selected to be studied again with the combined continuous-wave Doppler and duplex scanning method for possible popliteal artery entrapment syndrome. Two cases were discovered and verified by dynamic angiography guided by continuous-wave Doppler and treated surgically.
Adult↗
[Post-stenotic aneurysm following incarceration of the popliteal artery. Description of a case].
The paper reports a case of post-stenotic aneurysm following an Inshua type II incarceration of the popliteal artery which was treated surgically, and associated with concomitant popliteal venous thrombosis, with complete remission of all clinical symptoms. The paper underlines the rarity of this pathology and the even rarer association with homolateral thrombosis of the popliteal vein. Anomalies which may occur following the incarceration of the popliteal artery are discussed, as are the causes for dilatory degeneration.
Aged↗
[Unusual complication of surgery of popliteal artery aneurysm: report of a case and considerations on the surgical technique].
A popliteal artery aneurysm was submitted to an exclusion surgery and autologous reversed saphenous vein bypass. The proximal ligation of the popliteal artery was performed 3cm above the aneurysm. A large branch of the artery below this point remained patent maintaining a communication with a branch of deep femoral artery. Due to this fact residual circulation inside the aneurysm was observed. The patient was reoperated in order to ligate the collateral branch and resect part of the aneurysm. This kind of complication of the technique proposed by Edwards is not common and does not invalidate this technique preferred by most surgeons.
Aneurysm↗
[Aneurysms of the popliteal artery. Our clinical and therapeutic contribution].
The authors report their experience in 10 cases of popliteal artery aneurysms. By the data of the literature the popliteal artery is the second place most affected by aneurysmatic injuries, immediately after the abdominal aorta. The authors think that the optimal treatment is the by-pass with the autologous vein graft versus all other types of prostheses.
Aged↗
Usefulness of waveform analysis of popliteal artery in type II diabetic patients using gated magnetic resonance 2D-cine-PC imaging and 31P spectroscopy.
AIMS/HYPOTHESIS: We studied 76 patients with Type II (non-insulin-dependent) diabetes mellitus and 16 age-matched non-diabetic subjects (control group) to clarify qualitative and quantitative abnormalities of waveform and flow volume of the popliteal artery. METHODS: The 76 diabetic patients comprised 16 patients with occlusive arterial disease in the lower extremities [arteriosclerosis obliterans (ASO) group] and 60 patients free from this disease (non-ASO group). We flow analysed the popliteal artery and measured the phosphocreatine to inorganic phosphate ratio of resting plantar muscles to identify risk factors for foot lesions using gated magnetic resonance two-dimensional cine-mode phase-contrast imaging and 31P spectroscopy. RESULTS: The control and non-ASO groups had a triphasic waveform with systolic, early and late diastolic components. All ASO patients had an abnormal monophasic waveform and a lower ankle brachial index than that of the control and non-ASO groups. To clarify the mechanism of reduced flow volume of lower extremities, we assigned the 60 patients of the non-ASO group to the three subgroups based on their levels of total flow volume of the popliteal artery. The lowest group showed an abnormal triphasic waveform with lower amplitudes of systolic and late diastolic components and flow velocities in foot arteries than those of the highest group although ABI was similar. From stepwise multiple regression analysis, late diastolic flow volume was identified as an independent determinant for the phosphocreatine to inorganic phosphate ratio (r2 = 0.484, p < 0.001). CONCLUSION/INTERPRETATION: Waveform analysis of popliteal artery provides a powerful tool for identifying impaired peripheral circulation caused by either occlusive arterial disease or increased arterial resistance in diabetic patients.
Adult↗
[Adventitial cyst of the popliteal artery. Imaging and percutaneous treatment].
Adventitial cystic disease of the popliteal artery is a rare cause of calf claudication in young patients. A case explored by magnetic resonance imaging is reported: a water rich mass around the popliteal artery compressed the arterial lumen. Treatment consisted in CT-guided percutaneous aspiration. Good functional outcome except for severe efforts, despite persistance of cystic images was observed. Echography, computed tomography or magnetic resonance imaging are more useful to establish the diagnosis than arteriography because these techniques can directly visualize the arterial wall. Percutaneous treatment preserves the intima and can be performed in out-patients. When feasible, it could be preferred to conventional surgery.
Adult↗
Traumatic popliteal artery pseudoaneurysms: case report and review of the literature.
Traumatic pseudoaneurysms of the popliteal artery are an uncommon late complication of arterial injury. Although reviewed extensively in wartime, they occur less frequently in civilian trauma and have accordingly been less frequently studied. A case report of a traumatic popliteal artery pseudoaneurysm and review of the literature are presented.
Aneurysm↗