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We report a case of cystic adventicial disease of the popliteal artery in a 67 years old man. The realisation of the intra arterial pressure measurements, and the peroperative echography permit to diagnose important associated lesions of the intimal part of the arterial wall.
Adventitial cystic disease of the popliteal artery (ACDPA) is an unusual cause of a unilateral progressive intermittent claudication in young or middle-aged men. In the case described here, ultrasound (US) examination provided the preoperative diagnosis. The lesion was dealt with by simple evacuation of the cyst and excision of the wall. This simple treatment is all that is required in the majority of cases and provides good long-term results.
A "suspended" popliteal artery (S.P.A.) constitutes one of the most pejorative anatomical forms for atheromatous lesions of the lower limbs, as obliteration of the superficial femoral artery is often associated with atheromatous lesions in the tibial arteries, making them inaccessible to arterial reconstruction. Operations have been conducted on 5 cases (14 patients) over a period of 3 years. The average age of the patients was 71.6 years and the average follow-up period was 13 months. In each case operation was required to avoid amputation. Venous material was used for the shunt in 10 cases, while 5 had composite (n = 3) or prosthetic (n = 2) material. Postoperative mortality was nul, but 28% died by the end of the first year. Thrombosis occurred in 3 cases, at the 2nd, 7th, and 9th month respectively (actuarial permeability rate after 1 year: 72%), and 4 patients had high amputations (leg: 3, thigh: 1) in spite of permeability of the shunt is two cases (actuarial conservation rate of the limbs after 1 year: 67.5%). An analysis of the results of these 15 cases and those rare series reported in the published literature, enables definition of the indications for revascularization of an S.P.A.
Three young patients with an isolated popliteal artery occlusion are presented, two with severe claudication and the third with a critical ischaemic foot. The work-up of these patients leads to certain aetiologic possibilities: microtrauma, smoking and contraceptive pills. Two of our patients underwent thromboembolectomy, the third managed conservatively. The follow-up was between six months and seven years and up to now all three patients remain well.
Blunt trauma to the knee has been associated with both musculoskeletal and neurovascular injury to the leg. Popliteal artery thromboses secondary to such trauma can be complicated by a compartment syndrome. The loss of distal pulses in the leg following blunt knee trauma should always be attributed to a suspected vascular lesion and not to the presence of the compartment hypertension. We present a case in which the diagnosis of a popliteal artery thrombosis was delayed because the loss of distal pulses was initially attributed to the compartment syndrome.
Knee dislocation is an uncommon lesion. It is, however, frequently associated with injury to surrounding structures. The possible coexistence of trauma of the popliteal artery is a serious threat to the limb's integrity. Its incidence is high (about one third of cases) and, unless speedily discovered and treated, it leads to limb loss. Three cases of knee dislocation with combined injury to the popliteal artery successfully underwent surgery. On the basis of such experience, the authors survey the questions of vascular reconstructive surgery that still remain open: in particular, the delay in diagnosis, when and if to use angiography, the type of vascular reconstruction, the maximum delay in revascularization.
The paper reports a case of popliteal artery entrapment syndrome (3rd type) associated with poststenotic aneurysm with a single painful ischemic attack. Diagnosis was made following an accurate anamnesis and clinical examination using invasive and non-invasive instruments. Surgical therapy consisted of resection of the gastrocnemius muscle followed by a graft to the self inverted saphena vein.
PURPOSE: To evaluate the safety and efficacy of the Wallgraft Endoprosthesis for the treatment of femoropopliteal artery aneurysms. METHODS: From October 1997 to April 2000, 17 patients (13 men; mean age 73.5 +/- 7.1 years) with 7 femoral and 13 popliteal artery aneurysms underwent percutaneous aneurysm exclusion using the Wallgraft Endoprosthesis as part of a larger clinical trial. The mean aneurysm diameters were 37.6 +/- 12.9 mm and 22.3 +/- 8.7 mm, respectively. RESULTS: Acute procedural success was 100% for femoral aneurysms and 92.3% (12/13) in the popliteal artery owing to one endoleak that resolved after 1 month. There were no complications, and the mean length of stay was 2.2 +/- 3.8 days. Six-month and 1-year aneurysm exclusion rates were 100% for both locations, but 4 (31%) popliteal stent-grafts thrombosed in follow-up. Three were recanalized, but the fourth underwent bypass grafting after 3 thrombotic episodes. The 1-year primary and secondary patency rates were both 100% for the femoral aneurysms and 69% and 92%, respectively, for popliteal repairs. No procedure or device-related deaths occurred. CONCLUSIONS: Treatment of aneurysms in the femoropopliteal segment appears to be safe and effective with the Wallgraft Endoprosthesis, although longer follow-up in a larger patient group will be needed to determine this technique's potential versus surgical repair.
OBJECTIVE: To present the results of the endovascular treatment of popliteal artery aneurysms. METHODS: From April 1999 to January 2002, 11 patients, aged 40-94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to an aneurysm rupture. Aneurysm diameter was 28-105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case. RESULTS: During a mean follow-up of 14 (3-31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively. CONCLUSION: Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results.
Recent reports have emphasized the benign nature of trampoline-associated injuries. However, this study describes the limb-threatening problem of popliteal artery thrombosis occurring in association with anterior knee dislocation and trampoline injuries. Three children (ages 11, 13, and 17) were referred to the emergency room within the past 12 months with anterior dislocations of the knee, which occurred while jumping on trampolines. All patients had reduction of their dislocations at outside facilities and were referred within 6 to 12 hours after their injuries, with pulse, motor, and sensory deficits. All patients were taken directly to the operating room, where arteriography confirmed thrombosis of the popliteal artery below the knee. One patient had transection of the artery, whereas two patients had stretch injuries with intimal separation. Each patient required interposition grafting with reversed saphenous vein and underwent concomitant four-compartment fasciotomy. All patients had persistent sensory and motor deficits postoperatively, which were presumed to be a combination of ischemic injury and neuropraxia. All patients have functioning grafts with an average follow-up of 1 year (range, 9-15 months). One patient required a second interposition graft to treat an area of intimal hyperplasia, which developed at the proximal anastomosis, at 6 months postoperatively. Eighty per cent of trampoline injuries are associated with minor injuries with minimal long-term complications. However, dislocations of the knee may be associated with significant arterial injury and amputation rates of up to 30 per cent in many blunt trauma series. Based on our experience, physicians should recognize the possibility of significant arterial injuries occurring in children with anterior knee dislocations while jumping on trampolines.
Injury to the popliteal artery is reported in two patients with closed ligament injuries of the knee, and no fracture or dislocation. The importance of careful assessment of the circulation in this type of patient is emphasised.
This is a case of a 12-year old boy who sustained gunshot injury to his left knee region. After initial debridement and closure of his wounds, the patient presented seven weeks later with a large pulsatile swelling of his lower thigh and painful flexion deformity of his knee. Angiography revealed large pseudoaneurysm of the popliteal artery and arteriovenous communication. The patient underwent successful repair of his popliteal artery with autologous long saphenous vein graft. The initial diagnostic difficulty in these cases, the different types of injury and the therapeutic modalities of similar cases in the literature are discussed.
A case of mycotic aneurysm of the popliteal artery, following right hemicolectomy for carcinoma, is described. This was treated by ligation and excision without bypass grafting. The clinical features are discussed and the literature reviewed.
Two cases of popliteal artery entrapment syndrome are added to the previously reported three cases from China. The details of the history, physical findings, and treatment of these two cases are presented, with a general discussion of the syndrome.
Acutely occluded lower leg arteries in a patient with a chronically obstructed superficial femoral artery were successfully treated by catheter lysis and dilatation via the popliteal artery.
The internal mammary artery (IMA) is the graft of choice for coronary artery bypass surgery because of its resistance to atherosclerosis. Studies to elucidate the mechanism of this phenomenon have focused on vasoactive properties of the vessel wall; however, low thrombogenicity might also contribute to the protection of the IMA against atherosclerosis. To test this hypothesis, copper coils 3 mm long were introduced in 14 heparinized dogs into both the IMA and the left anterior descending coronary artery (LAD) (n = 7) or into both the IMA and the popliteal artery (POP) (n = 7). Arterial patency was monitored angiographically at 15-minute intervals for 4 hours. Occlusion occurred in all LADs and POPs and in 10 of the 14 IMAs. Spontaneous reflow after occlusion occurred in all IMAs and was followed by cyclic reocclusion and reflow in two animals. Short periods of reflow followed by reocclusion occurred in two of the seven LADs and three of the seven POPs. The patency status, categorized as persistent occlusion, reflow followed by reocclusion, reflow without reocclusion, or persistent patency, was significantly different between IMA and LAD (p less than 0.02) and between IMA and POP (p less than 0.04) but not between LAD and POP. Patent arteries at the end of the 4-hour period were observed in all of the 14 IMAs versus none of the seven LADs and two of the seven POPs (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
In three patients operated on for intermittent claudication in 1953, 1954 and 1956, respectively, the pathology causing the obstruction was localized cystic adventitial degeneration of the popliteal artery. On examination 27 to 30 years postoperatively the grafts were all patient, but showed some widening and irregularity. The vein grafts had thus stood a rather long test of time. There were no signs of relapse of the non-atherosclerotic disease of the femoro-popliteal artery. None of the patients had any history of knee injury or joint swelling.
We report four patients who presented early in life with intermittent claudication, caused by popliteal artery entrapment. In three of them this was the result of an abnormality in the anatomy of the popliteal fossa. In the fourth, however, muscular hypertrophy alone led to arterial entrapment. Three patients were successfully treated by simple myotomy. In the fourth arteriography showed a total occlusion of the popliteal artery. An arteriotomy was performed. In was then seen that the vessel was still patent, and the opening was closed with a vein patch. The result of this procedure was also satisfactory. It is the authors' opinion, based on their own experience and that of other workers as reported in the literature, that vascular reconstruction is only indicated when irreversible vascular changes have occurred, or where other lesions have complicated the condition.