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PubMedDate not supplied

Experimental remarks on leg ischemia following popliteal artery injuries.

Popliteal artery injuries are followed, in many cases, by amputation of the leg. Results after re-construction depend on the time of ischemia. In this experimental work 12 dogs with injury of the popliteal artery had a direct end to end anastomosis or an anastomosis using saphenous vein graft. Blood flow was checked by an electromagnetic flowmeter or ultrasounds, blood samples for Hb, oxyhaemoglobin saturation, Hct and ph were taken before and after operation. Changes in these values depend on the time elapsing between injury and re-establishment of circulation. Operative angiography was done in all dogs. Except in two dogs, no early or late thrombosis occurred. Three dogs required amputation. The outcome of the operation is related to the time elapsing between injury and restoration of circulation.

Animals↗
PubMed1993

[Recurrent acute occlusions of the popliteal artery before age 50: popliteal entrapment syndrome?].

Compression of the popliteal artery by the medial head of the gastrocnemius muscle is termed "Popliteal Artery Entrapment". The anatomical course of the artery can be normal or abnormal. The entrapment can cause occlusion of the artery or peripheral embolism. This syndrome is an important differential diagnosis in younger patients with recurrent peripheral arterial ischemia. Diagnosis is made by history, clinical findings, arteriography and CT-scan of the knees. All cases of popliteal artery entrapment, whether the artery is occluded or not, should be operated on.

Adult↗
PubMed1988

Long-term results of infragenicular bypasses with autogenous vein originating from the distal superficial femoral and popliteal arteries.

Forty-nine bypasses originating from the distal superficial femoral artery or popliteal artery in 46 patients were reviewed to examine late patency, limb salvage, and factors leading to graft failure. Operations were performed because of tissue loss in 86%, rest pain in 12%, and limiting claudication in 2% of limbs. Proximal anastomosis was from the distal superficial femoral artery in 12% and the popliteal artery in 88%. Distal anastomosis was to the below-knee popliteal artery or proximal tibial vessels in 20% and the distal tibial vessels in 80%. Life-table analysis showed a primary patency rate of 83%, 62%, and 41%, at 1, 3, and 5 years, respectively. The rate of limb salvage at 6 years for all grafts was 69%. Cox proportional hazards analysis determined that stenosis of 20% or greater in the proximal superficial femoral artery before bypass was a significant risk factor for graft failure (p = 0.02) despite the presence of normal intra-arterial pressure at the site of the proximal anastomosis at the time of bypass. Long-term survival in these patients was low, with a 6-year survival rate of only 24%. Infragenicular bypasses originating from the distal superficial femoral artery or the popliteal artery can be performed with patency and limb salvage rates comparable to bypasses originating from the common femoral artery. These bypasses are more likely to fail when performed in the presence of a stenosis 20% or greater in the superficial femoral or popliteal artery proximal to the graft origin.

Aged↗
PubMed1994

The surgical anatomy of the popliteal artery.

The popliteal artery is a common recipient site for above or below knee bypass grafts. It is also frequently affected by penetrating and blunt trauma involving the lower extremity. Exposure of this artery is, therefore, often required in both emergent and elective vascular procedures. In close proximity to the artery, within the confines of the popliteal fossa, are the tibial nerve, common peroneal nerve, and the popliteal vein. An understanding of the normal anatomy and the important variations in the popliteal bifurcation patterns is essential. In this report, we have combined data from new cadaver dissections with prior anatomical data to describe the anatomy of the popliteal fossa and important vascular anomalies.

Humans↗
PubMed1988

Popliteal arterial aneurysm.

Popliteal arterial aneurysms are rare in young individuals. A case without a penetrating trauma presenting in a young woman is described. Complications may lead to vascular emergencies. Early diagnosis and surgical treatment is important.

Adolescent↗
PubMedDate not supplied

Endovascular treatment of popliteal artery aneurysms.

Popliteal artery aneurysms are relatively uncommon but potentially limb-threatening lesions that can thrombose or cause distal embolization. Identification of these aneurysms, especially in patients with abdominal aortic aneurysms, is imperative, and prophylactic treatment with either surgical exclusion and bypass or endoluminal stent grafting is critical to prevent these poor outcomes. Endovascular approaches currently using the Viabahn stent graft offer several advantages, including a minimally invasive approach, fewer perioperative complications, and a faster recovery. This must be balanced with a potentially higher failure rate or requirement for reintervention, although contemporary series report comparable short-term outcomes. We present our approach to the evaluation and diagnosis of popliteal aneurysms, the technical aspects of endovascular popliteal aneurysm repair, and a representative case study.

Aged↗
PubMed1990

[Quantitative flow determinations in the superior femoral artery and the popliteal artery using angiodynography (color-coded duplex sonography) before and after percutaneous transluminal laser angioplasty].

The primary angiographic PTLA-success correlates with the angiodynographically measured blood flow. 24 hours after the treatment the measured flow values in the AFS and AP allow prognoses: 1. Flow volumes in the AP less than 15 ml/min do not allow successful PLTA-therapy. 2. Slight clinical improvement can be expected for flow values greater than 50 ml/min in the AFS and between 20 and 30 ml/min in the AP. 3. AP-values greater than 30 ml/min correlate in this pilot investigations with an excellent clinical result 4 months after intervention.

Angioplasty, Laser↗
PubMed2006

Follow-up of the aneurysmal sac after exclusion and bypass of popliteal artery aneurysms.

UNLABELLED: Popliteal artery aneurysms are frequent and may lead to thromboembolic events and limb loss. PURPOSE: To evaluate clinical and ultrasonographic follow-up of patients who underwent exclusion of a popliteal artery aneurysm using the technique proposed by Edwards. METHODS: Data of all patients who underwent surgery to repair a popliteal artery aneurysm at Hospital das Clinicas, the São Paulo University Medical School between 1996 and 2004 were reviewed. Inclusion criteria were repair with aneurysm exclusion and bypass using the technique proposed by Edwards, as well as the existence of preoperative and postoperative measurements of the aneurysmal sac. RESULTS: Data of 16 patients who underwent 20 procedures for popliteal artery aneurysm exclusion and bypass were available to analysis. The preoperative diameter of the popliteal artery aneurysms ranged from 1.3 cm to 6.1 cm (mean = 3.1 cm). Patients underwent duplex ultrasound scanning 1 month to 7 years after surgical repair. Follow-up of the 20 cases revealed that 10 aneurysms exhibited decreased mean transverse diameters, ranging from 0.2 to 2.3 cm, while 7 had increased in diameter, ranging 0.3 to 3.3 cm, and 3 remained unchanged. Flow was observed only in 5 out of the 20 procedures, 3 of which (60%) had increased diameters. CONCLUSION: Although exclusion is a widely accepted procedure for the repair of popliteal artery aneurysms, data in the literature and the results of this study, which did not include cases of rupture or compression, suggest that strict follow-up of patients who undergo aneurysm exclusion is necessary.

Adult↗
PubMed1983

The value of ultrasound in the diagnosis of popliteal artery aneurysms.

Although popliteal artery aneurysms are among the most common type of peripheral artery aneurysm, they may be difficult to diagnose until complications such as peripheral embolization, acute thrombosis and rupture occur. Pressure on adjacent structures may cause neurological symptoms and venous thrombosis. The diagnosis of peripheral artery aneurysms is usually made by physical examination and arteriography. Recently, ultrasound of the popliteal space has been found to be very useful in the diagnosis of popliteal artery aneurysms. It is therefore important to recognize the value of ultrasound for imaging popliteal artery aneurysms and to use this readily available non-invasive modality in patients in which physical examination and/or angiography of the popliteal fossa is equivocal. We present one case of a popliteal artery aneurysm which was missed by angiography and physical examination in which ultrasound was very important in diagnosing this aneurysm pre-operatively, and two cases in which the ultrasound examination confirmed the presence of the popliteal artery aneurysm but better delineated its size than did angiography.

Aged↗
PubMed1993

Computed tomography in the diagnosis and management of popliteal artery entrapment syndrome.

Popliteal artery entrapment by an anomalous band of the gastrocnemius muscle is an uncommon but apparently under-diagnosed syndrome. Historically, arteriography has been used to diagnose this condition, but the standard method may not demonstrate arterial deviation or differentiate entrapment from other conditions that affect the popliteal artery, such as cystic adventitial disease and thrombosed popliteal artery aneurysms. Computed tomography has become increasingly useful to vascular surgeons in elucidating arterial disorders of the popliteal fossa. This case demonstrates the usefulness of computed tomography evaluation in the diagnosis and management of popliteal artery entrapment.

Adult↗
PubMedDate not supplied

Stress MR imaging for evaluation of popliteal artery entrapment.

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young health volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.

Adult↗
PubMed2003

[Indirect relation between intimo-medial thickness of the carotid artery and vasodilation of the popliteal artery].

BACKGROUND: Intima-media thickness of the common carotid artery (IMT ACC) and flow-mediated vasodilatation (FMD) of the brachial artery is considered an early marker of atherosclerosis. This study was undertaken to elucidate whether endothelial dysfunction in the popliteal artery, pronoun to atherosclerosis, is related to IMT ACC. METHODS AND RESULTS: Twenty-nine control subjects, 29 asymptomatic patients with hyperlipoproteinemia (without therapy) and 26 patients with coronary artery disease were examined. Using ultrasound with a linear-array probe (7.5 MHz), we measured IMT ACC and diameter of the popliteal artery (PA) at rest and during reactive hyperaemia after release of 5-minute arterial occlusion. In control subjects we found thicker IMT ACC and greater FMD than did the patients (p<0.001, ANOVA test). A significant negative correlation between the IMT ACC and percent FMD was found in all of the subjects (p<0.001). On multiple regression analysis, percent FMD showed a significant negative correlation with the IMT ACC, total cholesterol, triacylglyceroles, body mass index, age, and diastolic blood pressure. CONCLUSION: We found significant negative correlation between IMT common carotid artery and FMD popliteal artery.

Adult↗
PubMedDate not supplied

[Early diagnosis importance for a correct surgical treatment of PAES (popliteal artery entrapment syndrome)].

Popliteal artery entrapment syndrome (PAES) is an uncommon pathological entity, caused by segmental popliteal artery compression by the surrounding myofascial structures. Clinical symptoms may appear acutely, with temporary ischaemic attacks, or chronically, with concerned calf claudicatio intermittens and for 30% are bilateral. Diagnosis, besides being based on clinical objectivity (acute and deep pain to the struck limb, mainly during active plantar hyperextension) and history-taking (subject-age and lack of atherosclerosis), is based on ultrasonographic (eco-color Doppler of the aortic-iliac-femural-popliteal trunks, tensiometric Doppler), angio-RM, angio-CT scan and dynamic angiographic exams. Treatment, essentially, is surgical by simple freeing of the popliteal artery from surrounding myofascial structures or by autologous vein (saphenous v.) interposition grafting and patching, or bypass without vessel resection. About clinical case reported by the authors, 44-years female with left calf acute pain symptoms, cold skin by the thermo-touch, hypo-paraesthesia with fifth toe cyanosis and walking inability, surgical treatment, because of precox diagnosis, consisted of simple cut of myofibrous shoot starting from medial head of the left gastrocnemious muscle and compressing popliteal artery, with clinical chart complete resolution.

Adult↗
PubMed1999

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome (PAES) is a rare cause of exercise-induced leg pain. Entrapment occurs because of an abnormal relationship between the popliteal artery and the surrounding myofascial structures in the popliteal fossa. Arterial insufficiency in the affected limb arises with entrapment of the artery, commonly giving leg symptoms with exertion. The true incidence of PAES in the general population is not known. The aetiology of PAES has an embryological basis related to the development of the popliteal artery and the surrounding musculature. Many different classification schemes have been developed to differentiate the various types of abnormal anatomy that are associated with the syndrome. Repeated popliteal artery compression causes trauma to the arterial wall, leading to premature localised atherosclerosis. The pathology of PAES is believed to be progressive, with arterial thrombosis occurring in some individuals as a natural progression of the disease process. Acute ischaemia can occur if there is an occlusion of the artery or thrombosis within an aneurysm. Clinically, up to 85% of individuals diagnosed with the syndrome are males. The mean age of individuals in a large series was 28 years. The condition can be found bilaterally in 25% of cases. Most individuals present with exercise-induced leg pain, the remainder presenting with acute or chronic ischaemia. The condition can result in significant functional loss for active individuals. Surgery has been advocated to prevent the progression of the disease that is believed to be the natural history of untreated PAES. However, the little research that has been done to determine the prognosis for individuals who have undergone surgery has focused on the patency rate of the arteries after surgery and the presence or absence of complications. Research needs to be done to look at the natural history of untreated PAES and the functional status of athletes after undergoing PAES surgery.

Arterial Occlusive Diseases↗
PubMed1997

[Minimal invasive therapy of aneurysms of the superficial femoral artery and the popliteal artery].

Percutaneous stent placement has been described for treatment of aneurysms as an alternative to surgical therapy. Literature reports of percutaneous minimal invasive therapy of peripheral aneurysms shall be reviewed and compared with our own results. Six male patients (51-69 years) with femoropopliteal occlusions related to aneurysms were treated percutaneously. In two cases Wallstents and in four cases polyester-covered nitinol stents were applicated. A clinical investigation including doppler-ultrasound was performed 24 hrs, 1, 3, 6, 12 and 24 months after the intervention. Stent placement succeeded in all cases. No adjunctive surgical treatment was necessary. Ankle-brachial-index (ABI) improved from 0.22 +/- 0.2 before to 0.74 +/- 0.2 24 hours after the intervention. One patient was lost for follow-up (Wallstent). A decrease of ABI and additional intraarterial angiography revealed stent-graft occlusion within one month (n = 2) and within three months (n = 1). One of these cases was successfully recanalized with local fibrinolysis therapy. In three patients patency of the stent persisted for 24 (+/- 2) months follow-up with three-vessel-supply of the calf. These results warrant further investigations for this minimal invasive method of percutaneous stent deployment as an alternative to surgical bypass treatment of femoropopliteal aneurysms. Time of hospitalization was reduced. At this time, surgical treatment of peripheral vascular aneurysms is gold standard.

Aged↗