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PubMed1979

A continuous wave Doppler velocimeter for monitoring blood flow in the popliteal artery, compared with venous occlusion plethysmography of the calf.

A transcutaneous Doppler velocimeter has been used for monitoring changes in blood flow in the popliteal artery during and after exercise of the calf muscles on a calf-ergometer. The instrument and the positioning of the probe are described. The validity of the Doppler measurements has been assessed by comparing results after exercise and after 5 min arterial occlusion with venous occlusion plethysmography. For 10 healthy volunteers calibration lines were found which are curved. This can be ascribed partly to alinearity of the Doppler instrument and partly to changes of the diameter of the popliteal artery. Displacement of the probe with respect to the artery, which influences the measured velocity signal, can be detected and to a certain extent corrected by taking into account the intensity of the Doppler signal. The largest deviation of a data point from the corresponding calibration line varies for the ten subjects between 90 and 170 Hz in the high flow range (mean Doppler frequency around 1000 Hz) and between 20 and 60 Hz in the low flow range (mean Doppler frequency below 200 Hz).

Adult↗
PubMed2003

Ruptured pseudo-aneurysm of the popliteal artery after percutaneous transluminal angioplasty.

An 88-year-old female presented with gangrene of two toes of the left foot. Angiography revealed a calcified occlusion of the left popliteal artery, 8 cm in length. Recanalisation was performed and the occlusion was successfully dilated. On day 13 after the procedure, the patient experienced acute pain in the left popliteal fossa. Ultrasound revealed a large pseudo-aneurysm of the popliteal artery. Angiography not only confirmed this finding but showed rupture of this pseudo-aneurysm. An above-knee amputation was performed. Pseudo-aneurysm formation at the site of previous PTA is considered as a rare complication and has not been reported in the literature. The incidence of pseudo-aneurysm formation at a PTA site is unknown because it is not routinely detected. Predisposing general and local factors are discussed. The present case illustrates that pseudo-aneurysms can cause other major complications with disastrous consequences for the patient. Pseudo-aneurysms after previous PTA should be treated by conventional bypass surgery or by endovascular means. Further studies should be undertaken to evaluate the risk of pseudo-aneurysm formation after previous PTA and to define which patients should be monitored closely.

Aged↗
PubMed1999

Popliteal artery entrapment syndrome: more common than previously recognized.

PURPOSE: This report summarizes our experience with the popliteal entrapment syndrome in 88 limbs (48 patients) treated during a 10-year period. METHOD: The study cohort consisted of a retrospective analysis of those patients who were seen with symptoms of claudication or severe ischemia by a single surgical group and in whom unequivocal evidence of popliteal entrapment was shown either with angiography or at the time of operation. The cases were collected prospectively in a private vascular surgical practice. RESULTS: Bilateral popliteal entrapment was found in 40 of the 48 patients. The mean age at the time of presentation was 35.0 years (SD, 11.6 years). Claudication was the most frequent presenting symptom (70 of 88 limbs). Types I, II, III, and IV popliteal entrapment were found in 58 limbs (15 arteries occluded), and 30 limbs (three occlusions) were seen with a "functional" popliteal artery entrapment (apparent absence of a developmental anatomic abnormality). Of the 18 limbs with severe ischemia and associated occlusion of the popliteal artery, 15 underwent bypass grafting with reversed saphenous vein grafts, all of which remained patent during the follow-up period (median follow-up, 4.2 years; range, 1 to 10 years). One popliteal artery occlusion that was treated with thrombectomy and vein patching occluded within 6 months and necessitated subsequent vein grafting. Two limbs with inoperable occluded popliteal arteries were not subjected to reconstruction (one necessitated amputation because of advanced ischemia, and the second had extensive thrombosis of the distal run-off). In two patients (four limbs), moderate presenting symptoms abated without surgery after the discontinuation of an extreme exercise program. The remaining limbs underwent surgical decompression (all popliteal arteries remained patent, with a median follow-up of 3.9 years). CONCLUSION: The popliteal entrapment syndrome is more prevalent than has formerly been appreciated. On the basis of observations made in this series and in the surgical literature, we advise surgical correction in all cases of types I, II, III, and IV entrapment at the time of diagnosis to avoid occlusion as a result of continued arterial wall degeneration. In contrast, decompression is only advised in those patients with "functional entrapment" if they have discrete and typical symptoms because up to 50% of the normal population may display transient popliteal artery compression with extremes of plantar flexion or dorsiflexion. On the basis of the severe histologic changes found in those popliteal arteries that had undergone occlusion at the time of presentation, it is advised that the popliteal artery should be completely replaced, ideally with a vein graft, when significant degeneration or occlusion of the popliteal artery is noted at the time of operation.

Adolescent↗
PubMed1995

[Aneurysm of the popliteal artery in a patient over 80 years of age].

The authors report an aneurysm in the popliteal artery surgically treated with success. The operation consisted on the installation of one tubular prosthesis femoro-poplitea with a termino-terminal anastomosis. The follow-up to 3 and 6 months from the operation showed good functional recovery.

Age Factors↗
PubMed1988

Blunt popliteal artery trauma: one hundred consecutive injuries.

An institutional experience with 100 consecutive blunt popliteal artery injuries over a 20-year period was reviewed. The overall amputation rate was 15%; however, during the past 7 years this has declined from 23% to 6%. Minimizing delay in the revascularization of ischemic limbs, routine systemic heparinization, primary arterial repair when possible, repair of popliteal venous injuries, aggressive wound debridement, and early soft tissue coverage have contributed to improved limb salvage during the 1980s.

Adolescent↗
PubMed1997

Popliteal artery entrapment syndrome: the role of early diagnosis and treatment.

BACKGROUND: The purpose of this study was to evaluate whether certain factors could influence arterial impairment at presentation for treatment of popliteal artery entrapment syndrome (PAES) and whether its early diagnosis could optimize long-term results. METHODS: Between 1979 and 1995, 30 patients were treated for PAES at our institution. Patients were characterized by age, risk factors, associated diseases, preoperative symptoms, affected side, dominant limb, duration of symptoms, musculotendinous structure causing the compression, arteriographic findings, arterial status at presentation, type of operation, postoperative complications, and long-term follow-up. RESULTS: Twenty-nine (65%) limbs underwent musculotendinous section (MTS), 15 (33%) limbs underwent vascular reconstruction, and 1 (2%) was surgically explored. Patients submitted to MTS were younger (mean, 31 +/- 3 years) than patients who underwent vascular reconstruction (mean, 41 +/- 4 years; p < 0.05). MTS limbs had a greater number of minor symptoms compared with those that underwent vascular reconstruction (62% versus 20%; p < 0.02). Arteriogram showed that MTS limbs had a greater number of normal findings at rest when compared with limbs that underwent conventional reconstruction (85% versus 0%; p < 0.001). No specific factors influenced the arterial status at presentation. During follow-up, treadmill examination revealed that MTS limbs had a better response (96%) than limbs that had undergone vascular procedures (67%; p < 0.02). MTS limbs had a better long-term patency rate (mean, 87 +/- 7 months) compared with limbs that were submitted to vascular reconstruction (mean, 107 +/- 8 months) (95% versus 65%; p < 0.02). CONCLUSIONS: Because PAES is a progressive disease that can create serious vascular obstructive disease and no specific factors seem to influence the degree of vascular impairment, the detection and treatment of PAES at an early stage permit better long-term results.

Adolescent↗
PubMed1975

Cystic adventitial disease of the popliteal artery.

The first case of cystic adventitial disease of the popliteal artery recorded in Canada is reported and discussed in conjunction with a review of the world literature of 45 reported cases. This rare cause of arterial insufficiency occurs usually in young men and should be considered in the differential diagnosis of claudication. Angiographic findings are diagnostic and surgery is usually corrective. The theories of etiology and pathogenesis are discussed and the gross and microscopic pathology is demonstrated.

Adolescent↗
PubMed2002

[Dilatation of the popliteal artery in hyperemia and intimal-medial thickness of the carotid artery in hyperlipoproteinemia, ischemic heart disease and in healthy individuals].

Non-invasive measurement of the intima-media thickness (IMT) of the carotid artery and flow-mediated dilatation (FMD) of the brachial artery are increasingly used as surrogate markers of vascular disease. Using ultrasound, we measured the diameter of the popliteal artery at rest and during reactive hyperaemia after release of 5-minute arterial occlusion. We also measured IMT of the common carotid artery. In 29 control subjects (average age 35 years) we demonstrated an increase in the diameter by 6.0 +/- 3.3% (p < 0.05), in 29 asymptomatic patients with hyperlipidemia (without therapy, average age 46 years) only by 0.9 +/- 3.0% and in patients with coronary heart disease (average age 50 years) only by 0.2 +/- 2.7%. The difference between patients and control subjects was highly significant (p < 0.001). IMT was 0.58 +/- 0.10 mm, 0.78 +/- 0.17 mm and 1.03 +/- 0.25 mm respectively (p < 0.001). We conclude that in patients FMD of the popliteal artery is smaller and IMT of the common carotid artery is thicker than in controls.

Adult↗
PubMed1975

Popliteal artery obstruction following Shiers total knee replacement. A case report.

Popliteal artery obstruction may occur following total knee replacement in cases of ankylosis with severe flexion contractures. Immediate recognition and documentation by arteriography is essential. Release of the musculofascial structures in the popliteal area with division of branches of the artery (without exposure of the joint or femur) may relieve the obstruction.

Adult↗
PubMed1988

Popliteal artery trauma: update and recent advances in management.

Management of vascular trauma has been standardized in the past two decades with a significant increase in limb salvage, but trauma to the popliteal artery still remains a challenge. A seven-year experience at San Bernardino County Medical Center was comprised of 20 popliteal artery injuries in 19 patients. Thirteen injuries (65%) were from blunt trauma, four injuries (20%) were from gunshot wounds, two injuries (10%) were from close-range shotgun blasts, and one (5%) was from a stab wound. Limb salvage was 100%. Liberal use of vein interposition grafts, routine intraoperative postreconstructive arteriogram, recognition of compartmental hypertension, and performance of fasciotomy were important steps taken to ensure a high limb salvage rate. Our standard technique at this time consists of repair of the artery with simultaneous repair of the dislocated knee and internal fixation of fractures.

Adolescent↗
PubMed1977

Injuries to the popliteal artery.

We have discussed our experiences in operative treatment of popliteal artery injuries. Healing depends on the elapsed time between injury and operation. Three patients brought to the clinic after eight hours required amputations because of irreversible changes caused by anoxemia.

Adult↗
PubMed1993

[Surgical treatment of aneurysms of the popliteal artery].

The authors report their experience of two cases of popliteal artery aneurysm. Both patients were treated with aneurysm resection and inverse saphenous vein bypass. Early surgical intervention is the only effective therapeutic tool to avoid serious complications of this pathology.

Aneurysm↗
PubMed1994

The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage.

BACKGROUND: Short vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. PATIENTS AND METHODS: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obvious coronary artery disease, and 28% had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93% of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). RESULTS: In-hospital mortality was 5.4%. Mortality at 24 months was 19% overall and 38% in patients with ESRD. Limb salvage was 77% at 3 years, 92% in patients with normal renal function versus 59% in those with ESRD (P < 0.003). Primary graft patency by life-table analysis was 94% at 1 month and 84% at 3 years. Five patients with patent grafts required amputation, 4 early and 1 late. Eight months after surgery, 1 patient (1.8%) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and successfully treated by percutaneous transluminal balloon angioplasty. CONCLUSIONS: Vein bypass grafts originating from the popliteal artery are effective and durable. Proximal disease progression rarely poses a significant threat to long-term graft patency. Patients with ESRD, blind tibial outflow tracts, and extensive forefoot lesions appear to be at increased risk of limb loss even with continued graft patency.

Adult↗
PubMed1976

Ultrasonic diagnosis of a popliteal artery aneurysm.

Ultrasound techniques are very effective in screening painful masses of the popliteal space. These techniques easily differentiate popliteal cysts from thrombophlebitis, and in addition permit sequential evaluation without patient discomfort or invasion. We report its use in diagnosing a popliteal artery aneurysm, another cause of a painful popliteal mass.

Aged↗