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PubMed1989

Surgical significance of popliteal arterial variants. A unified angiographic classification.

Distal popliteal arterial variations may influence the success of femorodistal popliteal and tibial arterial reconstructions. Two patients whose bypass procedures were initially unsatisfactory because of a poor choice for anastomosis stimulated a review of variations in the distal popliteal artery in 1000 femoral arteriograms. The popliteal arterial anatomy could be assessed in 605 extremities and the tibial arterial anatomy in 495 extremities. Seventy-five variant cases were identified. Normal branching of the popliteal artery was present in 92.2%. Among the 7.8% incidence of variants, the majority (72%) were either high origin of the anterior tibial artery or a trifurcation pattern. Of variant patterns to the foot (5.6%), the most common was that in which the supply to the distal posterior tibial artery arose from the peroneal artery. We propose a unified classification of the popliteal and tibial arterial variations that encompasses both anatomic areas. Variant arterial supply to the foot can be suspected when the infrapopliteal vessels show a hypoplastic or aplastic anterior or posterior tibial artery and compensatory hypertrophy of the peroneal artery. Knowledge of these variants is important to angiographers and vascular surgeons.

Angiography↗
PubMed1978

Popliteal artery aneurysms. Past and present.

Popliteal artery aneurysms have had an important historic role in the development of modern vascular surgery. Early methods of surgical therapy for these aneurysms are detailed in this report for a persepctive. Clinical aspects of surgical diagnosis and treatment of 35 popliteal artery aneurysms in 26 patients are also reviewed. Such aneurysms often present with varied symptoms and should be considered a treacherous disease entity since limb loss occurs in a considerable number of patients. Coexisting disease frequently complicates both the intraoperative and postoperative course of these patients. In this series of popliteal aneurysms, excision and venous autograft interposition offered the most successful operative therapy.

Aneurysm↗
PubMed1990

Successful repair of pediatric popliteal artery trauma.

Limb salvage after popliteal artery trauma in children demands the best in judgement and technique from the vascular or trauma surgeon. From September 1, 1985, through August 30, 1988, seven patients under age 18 were referred to our Center with popliteal arterial trauma. Four had blunt injuries and three had penetrating injuries. Associated injuries included three fractures, four severe soft tissue wounds, and one nerve injury. All patients underwent angiography, four preoperative and three intraoperative. Treatment included two primary repairs, four vein graft bypasses, and one fasciotomy and intraoperative angiography. Anastomoses were spatulated and sutured in an interrupted fashion. There were no deaths, amputations, or reoperations. At 10 to 42 months after repair, all patients have normal Doppler pressures and/or distal pulses. This study is the largest reported series of these challenging injuries. Contrasting with previous reports, it suggests that with prompt, aggressive treatment, a successful outcome may be anticipated.

Adolescent↗
PubMed1995

[Aneurysms of the popliteal artery].

The 45 patients with popliteal artery aneurysms have been treated at the Institute for Cardiovascular Diseases from Belgrade, during the last 36 years. Four of them were women and 41 men, with average age of 61 years. The incidence of bilateral localization was 28%. The aneurysms have been presented with the rupture in 6 cases, with deep popliteal venous thrombosis in 3 cases, with sciatic nerve compression in one case, and with acute or chronic leg ischemia in 38 cases. Seven small asymptomatic aneurysms have not been operated. The primary major leg amputation had to be done in 8 cases due to irreversible ischemic changes. Any form of reconstructive procedures has been done in 48 cases (total or partial aneurysmal resection with graft interposition, an aneurysmal exclusion and bypass procedures). The autologous saphenous vein graft has been used in 42 cases, PTFE in 5 cases and Bovin solco graft in one case. Three patient died intraoperatively due to massive myocardial infarction. The early patency rate was 91%, and limb salvage 93%. The follow-up period was between 2 months to 16 years (men 3 years). The long term patency rate was 86%, and limb salvage 97%. The surgical treatment is the method of choice in case of popliteal artery aneurysm, due to good results, and possible complications.

Adult↗
PubMed1990

Popliteal artery agenesis: a new anatomic variant.

Agenesis of the popliteal artery has not been described as a vascular anomaly in the lower extremity. This case report describes congenital absence of the popliteal artery discovered during operative exploration after a traumatic injury to the lower extremity. The preoperative arteriogram suggested acute occlusion of the popliteal artery. Intraoperative exploration and arteriography were consistent with agenesis of the popliteal arterial segment, and postmortem examination confirmed these arteriographic and intraoperative observations. Embryologically, failure of the middle portion of the sciatic artery to persist would account for this anomaly. A review of series reporting congenital anomalies of the lower extremity vasculature failed to discover previous mention of this particular abnormality. Agenesis of the popliteal artery should be included among those vascular anomalies that may affect management of lower extremity vascular disease.

Adult↗
PubMed1983

Limb-threatening potential of arteriosclerotic popliteal artery aneurysms.

Eighty-eight popliteal artery aneurysms were diagnosed in 59 men and two women (mean age 67 +/- 10 years). Bilateral aneurysms affected 27 patients (44%). Aneurysm diameter ranged from 1.3 to 12 cm (mean 4 +/- 2.6 cm). Most aneurysms were symptomatic (55%). Dominant symptoms included rest pain (19%), claudication (14%), local pain (13%), and gangrene (9%). The remainder of the aneurysms were asymptomatic (45%). Aneurysm thrombosis occurred in 24% of extremities. Associated aneurysms involved the abdominal aorta (62%), iliac artery (36%), and femoral artery (38%). Aneurysms that caused local pain were larger (6.2 +/- 1.9 cm) than asymptomatic aneurysms (2.9 +/- 2.1 cm, P less than 0.01). Aneurysms smaller than 2 cm were more likely to be asymptomatic than larger aneurysms (P less than 0.05). Operative intervention was undertaken for 56 aneurysms, with aneurysmal exclusion or excision with arterial reconstruction performed most often. Four primary and five secondary major amputations were associated with thrombosed aneurysms, compared to no amputations with asymptomatic aneurysms (P less than 0.01). Thirty-two aneurysms were not treated surgically. Limb loss resulted from ischemic complications which developed in 18% of aneurysms treated without operation. The duration of follow-up for patients who had operation and those who did not averaged 62 months and 25 months, respectively. Operative treatment for all bland popliteal artery aneurysms appears justified if complications leading to major amputation are to be avoided.

Adult↗
PubMed1998

Remote suturing for percutaneous closure of popliteal artery access.

We present a case of balloon angioplasty of the superficial femoral artery via a popliteal artery access with successful percutaneous vascular closure of the vascular access site (6-F Techstar). A femoral arterial approach had not been feasible due to previous aorto-femoral and femoro-femoral bypass operations. Clinical and ultrasound follow-up showed no complications up to 3 months after remote suturing.

Aged↗
PubMed2000

[Isolated popliteal arteries: results of surgical treatment and causes of failure].

UNLABELLED: Isolated popliteal artery is defined as an obstruction of a superficial femoral artery with a patent popliteal segment followed by an obstructed distal popliteal artery or a patent leg artery less than 5 cm long. PURPOSE: The aim of this retrospective study was to report the results of surgical treatment and the causes of failures. PATIENTS AND METHODS: From 1988 to 1996, 31 patients with isolated popliteal artery were operated on with femoropopliteal bypass. The age of the patients ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography and diagnosis was confirmed by intraoperative arteriography. RESULTS: In the postoperative course, there were 22 patent bypasses (68%) with minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, and a medical treatment in one. With a mean 37-month follow-up, seven thromboses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuarial patency rates of the bypasses were 51% at one year, 38% at two years and 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0% respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. No other statistically significant cause of failure was demonstrated among those analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment. CONCLUSION: Bypass to isolated popliteal artery is indicated in patients whose limb viability is jeopardized. Results may be considered as satisfactory especially if there is a run-off branch and if a venous graft is available for the bypass.

Aged↗
PubMed1985

Late mortality and morbidity after arterial reconstruction: the influence of arteriosclerosis in popliteal artery trifurcation.

Mortality and the incidence of myocardial infarction and cerebrovascular lesion have been retrospectively analyzed in patients who have survived 30 days after lower limb vascular reconstruction. These events have been related to the extent of arteriosclerotic lesions in the trifurcation of the popliteal artery (trifurcational disease, TFD) in 368 patients treated consecutively. One hundred fifty-five patients underwent aortoiliac reconstruction, 229 had femorodistal bypass, and 16 underwent both procedures. The median follow-up period was 4.4 years. The mortality rate in male and female patients was increased compared with the expected mortality. This increase was found both in patients with and without TFD. In patients having TFD the mortality was 2.0 times higher than in patients who did not have TFD (p less than 0.001). The difference in the mortality rate persisted after correction for the influence of age, sex, and diabetes mellitus. The higher mortality rate in patients who had TFD was most marked early in the postoperative period and was mainly caused by myocardial infarction. The incidence of myocardial infarction and cerebrovascular events was significantly increased in patients who had TFD compared with those who did not, particularly in the early postoperative period.

Adult↗
PubMed1995

Anatomo-radiological study of the popliteal artery during knee flexion.

We studied the morphological modifications of the popliteal artery during knee flexion. An anatomical, radiological study consisted of analysis of lateral arteriographs in different degrees in joint flexion followed by dissection to reveal the anatomical structures involved in the morphological adaptation of the popliteal artery to joint movement. In five non-atheromatous volunteers, 15 MRI angiographic sequences were done at the level of the knee in extension and flexion. The arteriographs and angio MRI showed that as joint flexion increased tortuosities appeared in the supra-articular upper popliteal artery while the middle and lower parts of the popliteal artery kept an even curve retracted from the posterior surface of the joint. Dissection seemed to show that this arterial adaptation occurred between two fixed points, one proximal (the adductor canal) and the other distal (the origin of the anterior tibial artery). Angio MRI seems to be a future route for the assessment of the limb vessels. The contrasting behaviour of the different segments of the popliteal artery allows us to understand better the pathophysiology of trauma and malpositions of the popliteal arterial trunk.

Humans↗
PubMed1999

Popliteal artery entrapment syndrome: arteriographic findings and thrombolytic therapy.

PURPOSE: To review the arteriographic appearance of popliteal artery entrapment syndrome (PAES) and functional popliteal artery entrapment, and determine the role of thrombolysis in the treatment of these disorders. MATERIALS AND METHODS: Retrospective review of hospital records from 1991 to 1998. RESULTS: Seven patients with PAES and one with functional entrapment were identified. The popliteal artery was occluded in two limbs and compressed in 13. Active plantar flexion was necessary to demonstrate impingement in nine limbs. Medial deviation of the popliteal artery was evident in six of 14 patent popliteal arteries, and lateral deviation was observed in one limb. "Classic" abrupt medial angulation of the popliteal artery was observed in one limb. Both limbs were involved in all six patients who underwent bilateral popliteal exploration. Thrombolytic therapy was performed in three limbs. In two instances, it permitted a less extensive surgical procedure than would otherwise have been required. CONCLUSIONS: There is considerable variability in the arteriographic appearance of PAES, which is arteriographically indistinguishable from functional entrapment. It is frequently bilateral. Thrombolytic therapy does not obviate surgery but may permit a less extensive procedure to be performed.

Adult↗
PubMed1984

Embolism of the popliteal artery.

The experience with popliteal arterial embolism at the Massachusetts General Hospital was surveyed, and the results of therapy prior and after the introduction of the balloon-tipped embolectomy catheter were compared. During the 17 year period from January of 1964 to January 1981, 67 popliteal emboli were diagnosed. Nonsurgical management was successful in salvaging 11 of 13 extremities in ten patients with one death. Surgical embolectomy was performed upon 54 extremities in 48 patients with 40 limbs salvaged and 11 deaths. Although the percentage of patients undergoing surgical therapy for popliteal emboli has dramatically increased since the introduction of embolectomy catheters, no improvement in limb salvage or in patient survival has resulted. In fact, the limb salvage rate has declined. Nonsurgical management in appropriately chosen patients is clearly successful. The results of this survey emphasize the necessity of early diagnosis and treatment as well as selective patient management. Recommendations for a therapeutic approach to popliteal emboli are presented which hopefully will improve the results.

Aged↗
PubMed1980

[Extrinsic compression of the popliteal artery (author's transl)].

Popliteal artery compression may be due to trapping of the artery, a tumor, or a subadventricial cyst. Diagnosis is suggested by the discovery of ischemia in a subject who is often young, this being an unusual finding. It is confirmed by dynamic doppler tests, ultrasonography, and vascular opacification. Eight cases of trapped popliteal, three of osteochondroma, and seven cases due to cysts were observed. Surgical treatment is regularly effective and can prevent complications of embolism and acute thrombosis.

Connective Tissue Diseases↗
PubMed1990

[A complex injury of the knee joint associated with a popliteal artery lesion--case report].

Injuries of the popliteal artery are frequent in the dislocations of the knee joint, and an early diagnosis of a lesion of the popliteal artery is the base for the successful treatment. Generally, in all the traumas in the region or proximity of the knee joint, it should always be taken into consideration a possibility of arterial injury. In our case there was a posterior knee joint luxation with evidently contused and thrombosed popliteal artery. The surgery was done in an inappropriate time (more than 14 hours after the injury), and consisted in a Goretex graft interposition, and following a ligamentary reconstruction a transitory arthrodesis with external fixator (AO) in one level was carried out, what can be a model for similar situations. A control arteriography immediately before the patient's discharge from the hospital showed an arterial passage, while clinically an evidently lesser posterior unstability existed. In the surgical managing of such injuries it is necessary an interdisciplinary approach, appropriate period of time and corresponding sequences of repairs.

Accidents, Traffic↗
PubMed1999

Injury to the popliteal artery and its anatomic location in total knee arthroplasty.

Injury to the popliteal artery during total knee arthroplasty (TKA) is a devastating complication. Although infrequent, these injuries can result in the need for further surgery, including revascularization or possibly even amputation. Several mechanisms are capable of producing direct trauma to the popliteal artery, including the use of posterior ret ractors. We investigated the proximity of the popliteal artery to the tibial joint surface during TKA to identify crucial steps in the procedure at which the artery was at highest risk for injury. TKA was performed on cadaveric specimens, and serial intraoperative arteriograms were taken throughout the procedure, demonstrating the potential for arterial injury by the instrumentation. Additionally, 50 transverse magnetic resonance imaging scans of unrelated knees were analyzed for the position of the popliteal artery relative to the midline of the tibial plateau as well as at a level 5 to 10 mm below this, at the site of a typical resection during TKA. All of the arteriograms showed the artery to be a lateral structure at the joint line. Additionally a posterior retractor placed the artery at risk when it was placed in a position lateral to the posterior cruciate ligament or when it was injudiciously inserted more than 1 cm into the soft tissues. Hyperextension of the knee, which might occur during preparation of the patella, produced dramatic tenting of the artery over the posterior joint line. These results demonstrate that the popliteal artery is at significant risk during TKA, particularly if posterior retractors are placed in a position lateral to the midline of the joint. Both hyperflexion and especially hyperextension produced severe deformities and kinking of the artery and would particularly jeopardize an artery with atherosclerosis. Our findings suggest that the popliteal artery may be at least risk during TKA if posterior retractors are placed medial to the midline of the tibial plateau and if care is taken to avoid extremes of both flexion and extension.

Adolescent↗
PubMed1997

Blunt popliteal artery injury: is physical examination alone enough for evaluation?

Failure to recognize popliteal artery injury and restore vessel continuity of flow after blunt trauma is a major cause of lower-extremity amputation and morbidity. A high index of suspicion and early recognition of the injury are paramount for limb salvage, especially with posterior knee dislocation. Traditionally, arteriography has been the test most widely used to ensure an expedient diagnosis and institution of appropriate treatment. More recently, some authors have tried to move away from routine arteriography and rely on physical examination alone without arterial evaluation to guide them on their course of treatment. Based on our experience, the presence of arterial pulses after blunt trauma and dislocation of the knee is not an absolutely reliable indicator to exclude an arterial injury. The high morbidity of a missed popliteal artery injury mandates arterial evaluation of the popliteal artery either by arteriography or ultrasonography. A patient is presented with multiple injuries including a posterior knee dislocation. He had completely normal lower-extremity pulses on initial examination and at the time of discharge, but was required to have emergency reoperation with a ruptured popliteal artery pseudoaneurysm 5 weeks later.

Adult↗
PubMed2004

Extrinsic compression of popliteal artery in asymptomatic athlete and non-athlete individuals. A comparative study using duplex scan (color duplex sonography).

AIM: Extrinsic compression of the popliteal artery and absence of surrounding anatomical abnormalities characterize the functional popliteal artery entrapment syndrome (PAES). The diagnosis is confirmed to individuals who have typical symptoms of popliteal entrapment and occlusion or important stenosis of the popliteal artery with color duplex sonography (CDS), magnetic resonance imaging (MRI) or arteriography during active plantar flexion-extension maneuvers. However, variable result findings in normal asymptomatic subjects have raised doubts as to the validity of these tests. The purpose of this study was to compare the frequency of popliteal artery compression in 2 groups of asymptomatic subjects, athletes and non-athletes. METHODS: Forty-two individuals were studied. Twenty-one subjects were indoor soccer players, and 21 were sedentary individuals. Physical activity was evaluated through questionnaires, anthropometric measurements, and cardiopulmonary exercise test. Evaluation of popliteal artery compression was performed in lower limbs with CDS, ankle-brachial index (ABI) measurements and continuous wave Doppler of the posterior tibial artery. RESULTS: The athletes studied fulfilled the criteria of high level of physical activity whereas sedentary subjects met the criteria of low level of activity. Popliteal artery compression was observed with CDS in 6 (14.2%) studied subjects; 2 of whom (4.7%) were athletes and 4 (9.5%) were non-athletes. This difference was not statistically significant (p=0.21). Doppler of the tibial arteries and ABI measurements gave good specificity and sensibility in the identification of popliteal artery compression. CONCLUSIONS: The frequency of popliteal artery compression during maneuvers in normal subjects was 14.2% irrespective of whether or not they performed regular physical activities. Both Doppler and ABI showed good agreement with CDS and should be considered in screening popliteal arteries in individuals suspected of PAES.

Adolescent↗