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At least 127 records · Page 7Linked to original sources
PubMed1989

Chronic pseudoaneurysm of the popliteal artery after blunt trauma.

Blunt trauma to the popliteal artery usually results in acute arterial damage that requires urgent repair. Most blunt trauma to the popliteal artery is associated with skeletal injuries. We report a patient who had a chronic pseudoaneurysm of the popliteal artery 10 years after minor blunt trauma to the popliteal fossa. The cause of the pseudoaneurysm and suggestions for the early recognition of these arterial injuries are discussed.

Aneurysm↗
PubMed2002

A rare case of atherosclerotic popliteal artery aneurysm in a young adult.

Popliteal artery aneurysms are not so clinically frequent but are the most common peripheral aneurysms. They usually affect older men aged over 60 and are caused by atherosclerosis. Whenever they occur in younger men, other more unusual etiologies such as trauma, infection, inflammatory arteritis or popliteal entrapment are responsible. In this paper we present the case of a young male with an atherosclerotic popliteal artery aneurysm without a history of penetrating trauma or other possible etiologies.

Adult↗
PubMed2006

Popliteal artery volume flow measurement: a new and reliable predictor of early patency after infrainguinal balloon angioplasty and subintimal dissection.

OBJECTIVE: We have investigated whether popliteal artery volume flow (PAVF) measured immediately after balloon angioplasties of the superficial femoral artery-popliteal segments (SFA/POP) was predictive of early (30 days) and mid-term (6 months) arterial thrombosis. METHODS: During the last 24 months, 203 patients (56% men) with a mean age of 73 +/- 9 years had 268 duplex-guided balloon angioplasties of the SFA/POP. Critical ischemia was the indication in 36%. Group I included 176 (66%) with stenoses, and group II had 92 (34%) with occlusions. All patients had completion duplex examinations that included three measurements of PAVF of below-the-knee popliteal artery. RESULTS: Early (30 days) thrombosis of the treated femoropopliteal arterial segment developed in 10 patients (3.7%), three in group I (1.7%) and seven in group II (7.6%; P < .04). All 10 cases of early thrombosis were in patients with TransAtlantic Inter-Society Consensus (TASC) class C (6/185, 3.2%) and D (4/26, 15%) lesions. Moreover, the 19% incidence (n = 4) of early thrombosis in patients with PAVF <100 mL/min (mean, 73 +/- 24 mL/min; range, 20 to 99 mL/min) was higher compared with the 2.4% rate for patients with higher flows (mean, 176 +/- 60 mL/min; range, 100 to 450 mL/min; P < .01). At 6 months of follow-up, femoropopliteal occlusions had developed in nine more patients, and it became apparent that low PAVF measurements were still predictive of thrombosis (29%) when compared with higher PAVF cases (6%; P < .002). Log-rank comparison of survival curves for cumulative primary stenosis-free patency in group I and group II demonstrated a statistically significant difference (P < .02). PAVF <100 mL/min and TASC classification were significant predictors of early (30 days) and mid-term (6 months) arterial thrombosis after femoropopliteal angioplasties. PAVF was the most powerful predictor of arterial thrombosis. The respective 6-month and 12-month limb salvage rates were 98% and 94% for patients with claudication and 88% and 85% for those with limb-threatening ischemia (P < .0001). CONCLUSIONS: Our results demonstrate that low PAVF is the most powerful predictor of early (30 days) and mid-term (6 months) arterial thrombosis after femoropopliteal interventions. In the presence of a low postprocedure PAVF (<100 mL/min), one may consider not reversing the heparin or using intermittent calf compression, or both, to augment the arterial flow.

Adult↗
PubMed2000

Popliteal artery entrapment syndrome: diagnosis and management, with report of three cases.

Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lowerlimb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. Early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.

Adult↗
PubMed1989

[Traumatic lesions of the popliteal artery].

Even today, traumatic lesions of the popliteal artery mean in a large percentage of cases (from 25% to 45% according to recent reports) loss of the extremity, notwithstanding the considerable advances made by reconstructive vascular surgery. The most important series are reported in relation to events of war in the past (Korea, Vietnam) and more recently. As for lesions in everyday life, the highest percentage is the result of road and particularly motorbike accidents. A review of the most recent literature shows that the prognosis for lesions of the proximal and middle segment of the popliteal artery is greatly improved while in lesions of the distal portion and particularly the trifurcation, the percentage of failure with consequent amputation is still very high (from 30% to 40% of cases). Here personal experience of 6 cases of lesions of the popliteal artery due to osteovascular trauma observed in the past two years is reported, the diagnostic procedures and therapeutic treatment adopted being discussed.

Accidents, Traffic↗
PubMed1994

Popliteal artery aneurysms: current management and outcome.

PURPOSE: Thrombosis of popliteal artery aneurysms can produce limb-threatening ischemia. In this setting we have found preoperative thrombolytic therapy to be beneficial. METHODS: Thirty-three patients with 54 popliteal artery aneurysms were studied (mean follow-up 62 months). Twenty-one patients (62%) had bilateral popliteal artery aneurysms, and 20 patients (61%) had extrapopliteal arterial aneurysms. Thirty-three (61%) aneurysms had symptoms of compression or ischemia, and 21 (39%) aneurysms had thrombosis. A trend toward thrombosis for larger aneurysms was noted (p < 0.068). RESULTS: Forty-five aneurysms were treated with bypass grafting. Five-year graft patency and limb salvage rates were 71% and 90%, respectively. Factors favoring graft patency and limb salvage included presence of two- or three-vessel runoff compared with patients with single- or no-vessel runoff (p < 0.025 graft patency; p < 0.003 limb salvage) and presence of a patent aneurysm (p < 0.005 graft patency and limb salvage). Seven patients diagnosed with thrombosis of their aneurysm and all runoff vessels were treated with preoperative thrombolytic therapy. Complete clearing of thrombus from these arteries was achieved in six of these patients (and from two of these runoff vessels in the remaining patient). These patients had better graft patency (p < 0.005) and limb salvage (p < 0.01) than comparable patients treated with emergency operations. Six amputations were performed in the follow-up interval, none of which were performed in patients having undergone thrombolytic therapy. CONCLUSIONS: It is concluded that popliteal aneurysms are managed best by elective repair of patent aneurysms with good runoff. In that difficult situation of the thrombosed popliteal artery aneurysm associated with acute leg ischemia, thrombolytic therapy safely and effectively provides patients with a more favorable alternative than emergency surgery.

Adult↗
PubMed1995

[Management of blunt injury of the popliteal artery].

PURPOSE: this retrospective study was undertaken to analyse our results with blunt popliteal artery injury and to detect flaws in our approach. MATERIAL AND METHOD: between 1979 and 1993, 31 consecutive patients with a blunt injury to the popliteal artery were retrospectively reviewed. RESULTS: 4 patients were in shock on admission from a popliteal artery bleed. One patient died before treatment. Primary amputation of the leg was performed in one patient because of extensive tissue destruction. Arterial reconstruction was performed in the remaining 29 patients: 1 patient died of associated injuries, 5 underwent subsequent limb amputation because of infection (in 2), tissular destruction (in 2) and persistent ischemia (in 1). A neurological deficit (mostly of the peroneal nerve) occurred in 13 patients. Increased ischemic time was noted in 6 patients because of non-optimal management: diagnosis of a popliteal artery occlusion was missed in 2 patients, and a rigid approach resulted in an excessive delay in revascularization in 4 patients. DISCUSSION: even though morbidity of blunt popliteal artery injury is greatly determined by the initial trauma, superimposed ischemia further jeopardizes the outcome. A more expeditive revascularization could be achieved in some patients by performing on-table angiograms, immediate fasciotomy to release tissue hypertension and by proceeding with the vascular repair before orthopedic reconstruction. However, if a complex orthopedic repair must be performed initially because of major instability, indwelling shunts should be inserted in the popliteal vessels to insure limb perfusion. CONCLUSION: it is postulated that a rational plan of management of blunt popliteal artery injury would decrease the adverse effect of ischemia, and would reduce overall morbidity.

Adolescent↗
PubMed1999

Recanalization of an occluded popliteal artery following posterior knee dislocation.

Posterior knee dislocation results in popliteal artery injury in up to one-third of cases. Prompt recognition and treatment of arterial injury is essential for limb salvage. We report a case of complete occlusion of the popliteal artery following posterior knee dislocation treated with saphenous vein bypass without exclusion of the injured arterial segment. Follow-up duplex scanning demonstrated a patent vein graft and a patent ipsilateral popliteal artery. This report suggests that, in some instances, a traumatically occluded popliteal artery may recanalize, and that revascularization with a bypass graft may be the preferred method of repair, particularly in young patients.

Child↗
PubMed2003

Popliteal artery trauma in a rural level I trauma center.

Popliteal vascular trauma has historically been an urban phenomenon. We hypothesized that rural popliteal artery injury would result more often from blunt mechanisms of injury (MOI), have a longer time to operation, and result in a higher amputation rate. We retrospectively reviewed all cases of popliteal artery injury from December 1994 to May 2001 at our rural trauma center. Age, gender, Injury Severity Score (ISS), MOI, scene transport versus transfer from a referring hospital, time to operation, and operative times were studied. Significance was determined by Student's t test with a P value < or = 0.05. Thirty-two popliteal artery injuries were found. Blunt trauma accounted for 50 per cent of the injuries. Eighty-eight per cent of the patients were transferred from a referring hospital. Patients transported directly from the scene had a higher ISS. Longer operative times translated into an increased need for fasciotomy. The amputation rate was 19 per cent. This is the first attempt to delineate the specific nature of rural popliteal artery trauma. The amputation rate was not different between the two different MOI and was independent of the time to operation. Of those patients receiving an amputation 83 per cent were transferred from another hospital and despite a statistically lower ISS still required an amputation.

Adult↗
PubMedDate not supplied

Fate of excluded popliteal artery aneurysms: should we change our current treatment?

Surgical repair of popliteal artery aneurysms is usually performed by vascular exclusion and femoro-popliteal bypass grafting via a medial route. The vascular exclusion of a popliteal artery aneurysm may, however, prove ineffective long-term. We report on a patient with a large popliteal artery aneurysm observed twelve years after conventional surgical treatment and discuss alternative surgical options to be considered for long-lasting effective popliteal artery aneurysm treatment.

Aged↗
PubMed1998

Acute effects of intermittent pneumatic compression on popliteal artery blood flow.

OBJECTIVES: To investigate the immediate effects of intermittent pneumatic foot and calf compression (IPFCC) on popliteal artery blood flow in symptom-free volunteers and to determine the reproducibility of color flow duplex imaging in the popliteal artery. DESIGN: Cohort study. SETTING: A university associated tertiary care hospital. PATIENTS: Forty lower limbs of 30 volunteers without symptoms or noteworthy risk factors of peripheral vascular disease. INTERVENTIONS: Popliteal artery blood flow was measured in the sitting position before, during, and after the application of IPFCC using color flow duplex imaging. The interobserver, intraobserver, and between occasion within-subject variability of the popliteal artery blood flow were evaluated in 5 symptom-free volunteers who had at least 5 color flow duplex imaging measurements taken at each of the above time points on 3 different days. MAIN OUTCOME MEASURES: The arterial diameter, peak systolic, end diastolic, and reverse-flow velocities were measured, as well as the duration of forward flow during diastole before, during, and after IPFCC. The same variables were measured in 5 separate volunteers by 3 different observers, on 3 separate days, at 3 separate times to determine reproducibility. RESULTS: Including all types of variability, the popliteal artery blood flow varied from 8% to 39% with a mean value of 19%. Since the diameter of the artery was obtained with less than 5% variability, the time average mean velocity was responsible for the high variation in flow. During application of the IPFCC, the popliteal artery blood flow increased significantly in all subjects (P<.001). The mean increase in the flow was 2.4 times the baseline values. The diameter of the arteries remained unchanged while the time average velocity increased significantly (P<.001). This velocity increase was due to marked elevation in the peak systolic and end diastolic velocities and diminution of the reverse-flow component, as well as a prolongation of the forward flow during diastole. After cessation of the pump, flow returned to baseline levels (P=.41) CONCLUSIONS: Ultrasound-derived popliteal artery blood flow measurements show moderate variability. The application of IPFCC greatly enhances popliteal artery blood flow. The flow increase is due to a dramatic drop in the peripheral vascular resistance as the peak systolic and end diastolic flow velocities increase and the reverse-flow component diminishes. Its role in the treatment of lower extremity occlusive arterial disease needs to be determined.

Adult↗
PubMed1999

Cross-sectional imaging in a case of adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery is an unusual condition of uncertain etiology, in which a mucin-containing cyst forms in the wall of the artery and produces lower extremity claudication, typically in young and middle-aged men. A diagnosis of adventitial cystic disease of the popliteal artery was made preoperatively in a 47-year-old man by means of several imaging modalities, including angiography, magnetic resonance imaging, and ultrasound. The pathological findings confirmed the suggested diagnosis.

Angiography↗
PubMedDate not supplied

Popliteal artery entrapment syndrome. Report of two cases.

We treated two patients with popliteal artery entrapment syndrome. In one, the popliteal artery was entrapped and obstructed in its abnormal course around the medial head of the gastrocnemius muscle, which was inserted into the femur laterally and cephalad (type II in Delaney's classification). In the other patient, the popliteal artery followed a normal course but was compressed laterally by the medial head of the gastrocnemius muscle, which was aberrantly inserted into the femur considerably higher and more lateral than usual, and was occluded. This could not be fitted into Delaney's or Insua's classification. Arterial reconstruction was successful with an autovein graft in the former case and an in situ bypass graft in the latter. We suggest a modification of type IV in Delaney's classification, so that when the popliteal artery is compressed by an aberrant muscular or tendinous structure in the popliteal fossa it can be included.

Adult↗
PubMed1997

Popliteal artery aneurysm: two case reports of acute lower limb ischaemia.

Two cases of thrombosed popliteal artery aneurysm causing acute ischaemia were described. This report emphasises the importance of early diagnosis and surgical intervention of this condition. We then present a brief review of clinical presentation and current management of popliteal artery aneurysm. Popliteal artery aneurysm commonly first present as acute lower limb ischaemia secondary to thrombo-embolism. Failure to recognise this limb-threatening condition can lead to delay in treatment and even limb loss. It is therefore important to increase awareness of this condition. Popliteal artery aneurysm warrants early surgical intervention, even in an asymptomatic stage because of its potential for serious complications.

Aged↗
PubMed2006

Anatomic localization of the popliteal artery at the level of the knee joint: a magnetic resonance imaging study.

PURPOSE: The anatomic localization of the popliteal artery in the mediolateral plane at the level of the joint line was investigated on axial knee magnetic resonance imaging (MRI) scans to study anatomic variations. METHODS: The transverse and central axes were described on axial MRI scans of 334 knees. The distance between the popliteal artery and central axis was measured; the course of the central axis bisected the posterior cruciate ligament in almost all of the cases. The differences in popliteal artery localization according to sex and side were analyzed. RESULTS: Whereas popliteal artery localization was lateral to the central axis in 94.3% of cases, it was on the central axis in 5.7%. The popliteal artery localization was not seen on the medial side of the central axis. There was no significant effect of sex and side. CONCLUSIONS: Arthroscopic surgeons performing posterior cruciate ligament reconstruction or interventions on the posterior horns of the menisci should bear in mind that the risk of arterial complication may be greater for cases having the popliteal artery on the central axis. In conclusion, preoperative evaluation of the popliteal artery with MR axial scans, especially in pericapsular arthroscopic procedures, may prevent popliteal artery injuries. LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients.

Adolescent↗
PubMed1985

Adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery is an unusual condition of uncertain etiology in which a mucin-containing cyst forms in the wall of the popliteal artery and causes symptoms of intermittent claudication, typically in young adults whose arteries are otherwise normal. Arteriography characteristically shows a smooth-walled, curvilinear narrowing. In the case described, a combination of findings from arteriography, computed tomography, and ultrasound resulted in a highly specific preoperative diagnosis.

Adult↗
PubMed2005

Popliteal artery injury: Royal Perth experience and literature review.

BACKGROUND: Popliteal artery injury is uncommon but poses a significant challenge in Australian trauma care. Blunt trauma and knee dislocations appear to be associated with higher amputation rates. The aim of the present study was to review the authors' experience with this condition and discuss the best approach to investigation and management. METHODS: The medical records of all patients with popliteal artery injury (n = 19) who were entered prospectively onto the Royal Perth Hospital Trauma Registry from 1995 to 2003 were reviewed. Their demographic data, investigations, primary operative procedures, fasciotomy, primary and secondary amputation rates and mortality were determined. RESULTS: There were 17 male and two female patients with a median age of 34 years (range 17-62 years). Most patients (84%) were under 40 years in age. Blunt trauma was the commonest cause of popliteal artery injury (68.4%), and 84.6% of the patients had associated skeletal injury. The amputation rate in the present study was 26.3% (5/19). There were no intraoperative or in-hospital deaths. Three of 13 patients (23%) with blunt trauma underwent amputation, compared to two of six (33.3%) with penetrating injury. Two of three amputee patients in the blunt trauma group had dislocated knees. CONCLUSION: Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with one or more of the following factors: extensive soft-issue injury, associated skeletal trauma, knee dislocation, and prolonged ischaemia time. Measures to reduce the amputation rate, ranging from more prompt diagnosis to modified surgical treatment techniques, are discussed.

Adolescent↗