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PubMed1997

Popliteal artery entrapment syndrome: diagnosis and management.

A variety of anatomical abnormalities may product an external compression of the popliteal artery, resulting in a thrombotic occlusion. Between 1983 and 1995, 9 patients presented a popliteal artery entrapment syndrome, bilateral in two cases. Ultrasonography, Angio-CT scan and MRI showed the abnormal structures and position of the popliteal artery on popliteal fossa. Arteriography detected an arterial compression in 6 limbs and occlusion in 4 limbs as well as an associated popliteal aneurysm in one patient and distal embolism in four. The abnormal medial head of the gastrocnemius muscle was resected in 8 limbs, while fibrous membranes were resected in 3 limbs. Autogenous vein replacement was performed in 4 cases of popliteal artery occlusion and following resection of a popliteal artery aneurysm in one case. All patients recovered. In the followup period, the occlusion of the arterial reconstruction occurred after 28 months in one patient, with a mild claudication. Noninvasive vascular imaging techniques may allow early diagnosis and management of PAES, avoiding popliteal arterial wall lesions and its occlusion, with a better outcome.

Adolescent↗
PubMed1997

Popliteal artery compression and force of active plantar flexion in young healthy volunteers.

PURPOSE: To define the prevalence of popliteal artery occlusion during active plantar flexion in normally active and highly trained young volunteers by measuring plantar flexion force and to assess the force level associated with popliteal artery occlusion. METHODS: Eighty-four limbs of 42 healthy subjects were studied. Eighteen subjects were highly trained athletes, and 24 were normally active persons. Plantar flexion was progressively performed in prone position against a scale. Plantar flexion force was measured in kilograms. After determination of the maximum strength (Pmax) of plantar flexion force, the level necessary to occlude the popliteal artery (Poccl) was assessed by continuously monitoring that vessel using color duplex sonography. RESULTS: Occlusion of the popliteal artery during plantar flexion was observed in 88.1% of the subjects and 77.4% of the limbs. No significant differences in prevalence were found between athletes and normally active subjects. The popliteal artery occluded at a mean plantar flexion force of 45.1 +/- 11.5 kg, which corresponded with 70.1% +/- 16.8% of the maximum force exerted during the provocation test. Poccl was not significantly different between lower limbs of athletes and nonathletes. Although in lower limbs of athletes the popliteal artery occluded at a significantly lower relative force as compared with normally active subjects (65.6% +/- 17.4% vs 74.5% +/- 17.4% of Pmax; p < 0.02), the difference was a result of two extremely low values found in a female athlete. CONCLUSION: Positional occlusion of the popliteal artery during active plantar flexion is commonly found in young healthy volunteers. Prevalence of the phenomenon depends on the force level exerted during active plantar flexion. Popliteal artery occlusion during active plantar flexion is not more frequent in athletes and occurs at a similar force level than in normally active subjects.

Adult↗
PubMed2004

The popliteal artery, an unusual muscular artery with wall properties similar to the aorta: implications for susceptibility to aneurysm formation?

OBJECTIVE: The popliteal artery is, after the aorta, the most common site for aneurysm formation. Why the popliteal artery is more susceptible than other peripheral muscular arteries is unknown. An important factor may be differences in arterial wall composition as compared with other peripheral muscular arteries, which in turn affect wall properties. These are however unknown. We studied the mechanical wall properties of the popliteal artery in healthy subjects. MATERIAL AND METHODS: An ultrasound echo-tracking system was used to measure pulsatile changes in popliteal diameter in 108 healthy subjects (56 female, 52 male; age range, 9-82 years). In combination with blood pressure, stiffness (beta), strain, cross-sectional artery wall compliance coefficient (CC), and distensibility coefficient (DC) were calculated. Intima-media thickness (IMT) was registered with a Philips P700 ultrasound scanner. RESULTS: The popliteal diameter increased with age, and was larger in male subjects than in female subjects (P<.001). Fractional diameter change (strain) decreased with age (P<.001), and strain values were lower in male subjects than in female subjects (P<.01). Accordingly, stiffness increased with age (P<.001), with higher stiffness values in male subjects (P<.01). DC decreased with age (P<.001), with lower DC values in male subjects (P<.01). CC decreased with age, with no difference between genders (P<.001). IMT increased with age (P<.001), with higher IMT values in male subjects (P<.001). The increase in IMT did not affect distensibility. CONCLUSION: The wall properties of the popliteal artery are affected by age and gender, not only with an increase in diameter, but also with an age-related decrease in distensibility, with male subjects having lower distensibility than in female subjects. This seems not to be the behavior of a true muscular artery, but of a central elastic artery, such as the aorta, and might have implications for susceptibility to arterial dilatation, as well as the association of aneurysm formation between the aorta and the popliteal artery. CLINICAL RELEVANCE: The popliteal artery is, after the abdominal aorta, the most common location for aneurysm formation in the arterial system. Why it is more susceptible than other arteries is unknown. This study shows that the wall function of the popliteal artery differs from other peripheral arteries, and instead show striking similarities to the abdominal aorta, indicating that the functional arrangement of arterial wall components are similar in the two arteries. This may have implications for the susceptibility to aneurysm formation, as well as the association of dilating disease between the popliteal artery and the abdominal aorta.

Adolescent↗
PubMed2003

Surgical management of popliteal artery embolism at the turn of the millennium.

Popliteal artery embolism has been a focus of study at the Massachusetts General Hospital for over 60 years. It is a formidable vascular problem with significant limb loss and mortality. To assess the impact of advances in cardiac and vascular therapies, we reviewed our outcomes over 12 years. A retrospective review from our databases identified 66 patients with 72 popliteal artery emboli between January 1989 and October 2000. Patients undergoing nonsurgical therapy or with in situ atherosclerotic thrombosis were excluded. Demographics, comorbidities, presentation, duration, etiology, treatment, and outcomes were analyzed. Patients were classified into those with acute (AP; symptoms <7 days; 59 of 72, 82%) or delayed (DP; symptoms >7 days; 13 of 72, 18%) presentation. The presentation was typically acute ischemia (85%) in the AP group and claudication (69%), rest pain (15.5%), or gangrene (15.5%) in the DP group. The most common etiology was embolism secondary to atrial fibrillation (17 of 72, 24%). Femoral artery access (15 of 72, 21%) was more prevalent than in our prior experience. In the AP group, 9 of 59 (15%) were treated with a femoral artery approach, 44 of 59 (75%) with a popliteal artery approach, and 6 of 59 (10%) with bypass. In the DP group, 11 of 13 (85%) were treated with a popliteal approach and 2 of 13 (15%) with bypass. Completion angiography was done in 17 cases (24%). Limb salvage rate was 88% (88% AP, 85% DP); the rate was 94% with angiography and 85% without it (p > 0.1). There were seven deaths (10%). The mortality rate was 33% after amputation and 7% after limb salvage (p < 0.05). Except for a greater prevalence of femoral artery access as an etiology, the demographics of patients with popliteal embolism were similar to those of prior reports. Although a femoral approach may be appropriate in select AP cases, a popliteal approach is preferred in most patients and is necessary in DP cases. Completion angiography should be performed to ensure adequacy of the embolectomy. Outcomes are unchanged. Future therapies should aim to improve limb salvage and mortality rates.

Aged↗
PubMed2006

Size of normal and aneurysmal popliteal arteries: a duplex ultrasound study.

OBJECTIVE: To define diameter at three levels along the popliteal artery and its relation to the inflow arteries in the normal state and in popliteal aneurysms. METHODS: The external diameter of the arteries was determined by duplex ultrasound scanning at the common femoral (CFA), superficial femoral artery (SFA), proximal popliteal artery (PPOP), mid-popliteal artery (MPOP), and distal popliteal artery (DPOP). Examinations were performed in 104 healthy men and 100 women. In addition, patients were screened for the presence of popliteal aneurysms (diameter >10 mm). Findings in healthy male subjects were compared with those with popliteal aneurysms. RESULTS: Mean arterial diameters in normal men were larger than in women, but the SFA/CFA ratio was smaller in women (0.74 +/- 0.08 vs 0.78 +/- 0.09; P < .001) and the MPOP/SFA ratio was larger (0.98 +/- 0.11 vs 0.94 +/- 0.12; P = .001). In both genders, normal popliteal artery diameter was not uniform throughout its length, with PPOP and MPOP being nearly identical, and DPOP was smaller. MPOP diameter correlated most closely with SFA diameter (r = 0.51; P < .001) and less with height, weight and body surface area (r = 0.2 to 0.3) and was not associated with age or the presence of hypertension. In 27 men with 45 patent, fusiform popliteal aneurysms (10 to 44 mm) the site of maximal dilatation was in the region of the MPOP in 39 cases and near the PPOP in only 6 cases. The DPOP was never the largest segment and only in one case was it >10 mm. Arterial diameter in aneurysm patients was larger than normal at all levels but was greatest near the MPOP level (15.7 +/- 6.9). Popliteal-to-SFA diameter ratios were increased in the aneurysm group at all three levels but were greatest at the MPOP level (1.85 vs 0.94, P < .001). Comparing 15 popliteal aneurysms >20 mm with smaller ones, distal popliteal artery changed to the least extent but did increase in diameter (6.1 +/- 1.2 vs 7.0 +/- 1.4, P < .04). In larger aneurysms the MPOP/SFA ratio increased from 1.54 to 2.5 (P < .001). CONCLUSION: The diameter of the normal popliteal artery is not uniform throughout its length. In popliteal aneurysms, the region of the MPOP is most commonly the largest diameter. The MPOP/SFA ratio is greater than normal in popliteal aneurysms and increases in larger aneurysms. DPOP does dilate but to a lesser extent then PPOP and MPOP, making endovascular repair anatomically feasible in most popliteal aneurysms.

Aneurysm↗
PubMed1995

Popliteal vein compression due to popliteal artery aneurysm: effects of aneurysm size.

Unlike the venous compression associated with larger popliteal artery aneurysms, which frequently is associated with deep vein thrombosis, the venous compression caused by the moderate sized (greater than 2 cm and less than 3 cm) aneurysms in the reported cases is not associated with thrombosis. The extrinsic compressive effect of these moderate sized popliteal artery aneurysms on the adjacent vein is shown to vary with the patient's leg position. Three of the four patients with unilateral leg swelling discussed here had bilateral popliteal artery aneurysms. In these cases, the contralateral leg had a small popliteal aneurysm (less than 2 cm) and no leg swelling was present. The cases suggest that popliteal artery aneurysm size is an important factor in determining the type of venous obstruction that results from the extrinsic compression of the ipsilateral popliteal vein. The described phenomenon of a popliteal artery aneurysm having the effect of restricting flow in the ipsilateral popliteal vein must be included as a differential diagnosis among the causes of unilateral leg swelling in the absence of deep vein thrombosis.

Aged↗
PubMed1998

Outcome after early treatment of popliteal artery aneurysms.

BACKGROUND: Aneurysms of the popliteal artery are rare events with an estimated incidence of 0.1-2.8%. Their clinical importance depends on their propensity to cause thromboembolic complications or to rupture (18 to 31% of cases). This study was designed to assess the advantages of elective treatment of asymptomatic popliteal artery aneurysms so as to avoid the severe clinical manifestations that eventually arise if they remain untreated. METHODS: From 1980 to 1995, in our department we treated 28 popliteal aneurysms in 23 patients (19 elective operations and 6 emergencies). Three of the aneurysms proved amenable to fibrinolytic therapy alone. Follow-up lasted a mean 48 months (range 3 months to 15 years) in 20 patients (23 revascularizations). RESULTS: Global patency was 91.3%. Two thrombosed bypasses were treated by thrombolysis; in one case it did not resolve the ischaemia and the leg was amputated. In one case only, a graft became infected but this responded to conservative therapy with drainage and antibiotics. CONCLUSIONS: These findings suggest that popliteal aneurysms with good distal run-off should be repaired electively. Completely thrombosed aneurysms with coexistent limb-threatening ischaemia should be treated initially by thrombolysis. This will usually restore run-off and in some cases offers a valid alternative to emergency surgery for limb salvage.

Aged↗
PubMed1981

Adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery has been treated surgically in two patients. Both patients were young men, otherwise healthy, in whom disabling calf claudication developed. Arteriography demonstrated a crescentic defect in one patient and near-total midpopliteal occlusion in the other. Resection and a bypass graft resulted in complete relief of symptoms. This disease should be considered when examining a young person with claudication. The differential diagnosis of claudication in a young adult is primarily between this entity and popliteal artery entrapment syndrome.

Adult↗
PubMed1992

Case report 723. Popliteal artery aneurysm.

An unusually large, noncalcified popliteal artery aneurysm causing cortical erosion was erroneously diagnosed as a soft-tissue sarcoma. The case stresses the importance of excluding a vascular cause of a mass whenever biopsy is considered. We review the clinical and radiological features of popliteal artery aneurysm and describe the appearance of the aneurysm on MR.

Aged↗
PubMed1982

Radionuclide angiography of the popliteal arteries in occlusive vascular disease.

Before undertaking a femoro-popliteal bypass graft it is important to know whether the popliteal artery is patent to receive the distal end of the graft. Patency was assessed in 48 studies of 46 patients with peripheral vascular disease by radio-nuclide angiography. The procedure consists of imaging the popliteal arteries using a gamma camera after a bolus injection of 99mTc-sodium pertechnetate. The radio-nuclide angiograms were compared with the operative X-ray popliteal angiograms. Reliable information was obtained from the radio-nuclide images regarding the patency of the popliteal artery provided a femoral pulse was present. Quantitative data generated from the activity time curves were of no value in assessment of the patency of the popliteal arteries.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Claudication type lower limb pain in an athlete without atherosclerotic risk factors: a case of cystic adventitial disease of the popliteal artery.

Cystic adventitial disease (CAD) of popliteal artery is a rare cause of lower limb claudication. Since its first description in 1947 only about 323 cases have been reported in the literature. We report the case of a 45 year old man with CAD of the popliteal artery causing progressive left lower leg claudication detected by US and Doppler US and characterized with spiral CT angiography. No communication with the knee joint could be demonstrated.

Arteriosclerosis↗
PubMed1988

Lateral approach to the popliteal artery.

A lateral approach to the popliteal artery is described. The anatomic limits of the exposure, appropriate technical maneuvers to maximize this exposure, and alternative procedures are discussed. Groin or thigh infections in patients requiring urgent revascularization are the most common indications. However, some traumatic injuries and certain elective reconstructions are appropriately treated with this technique. The lateral exposure to the popliteal artery is not technically demanding and offers a useful alternative for treatment of selected vascular problems.

Adult↗
PubMed2005

Endoluminal angioplasty of the popliteal artery. Review of 54 consecutive patients.

AIM: To determine the results of endoluminal angioplasty for occlusive or stenotic lesions of the popliteal artery. METHODS: Retrospective study of symptomatic patients having popliteal occlusive lesions treated by endoluminal balloon angioplasty. All patients underwent systematic preoperative and postoperative color duplex scan and preoperative angiography. The principal endpoints were primary and primary assisted patency. RESULTS: Fifty-four percutaneous endoluminal angioplasties of the popliteal artery, including six procedures with stents, were performed in 50 patients. In all cases, the superficial femoral artery was patent and without significant stenosis. Primary patency for the entire cohort was 57.4+/-6.7% at 1 and 2 years. Primary assisted patency was 86.3+/-4.8% at 1 year, and 79.1+/-5.9% at 2 years. The results of angioplasty appeared to be better in patients with intermittent claudication when compared to patients with critical limb ischaemia, (p=0.0006). Angioplasty of single occlusive lesions had a better prognosis than that of multiple occlusive lesions (p=0.01). Results of angioplasty were better at the below-knee and median popliteal artery than at the femoro-popliteal junction or in the above-knee popliteal artery (p=0.03). Tibial run-off and isolated popliteal stenosis versus isolated popliteal thrombosis did not seem to affect primary patency rate. CONCLUSION: Results of angioplasty of the popliteal artery are acceptable for claudicants, especially those with TASC-A lesions and those with lesions in the distal two thirds of the popliteal artery.

Aged↗
PubMed1979

Summary of cases of adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery is explored. The results of correspondence with authors reporting this condition are elaborated upon. This has provided an opportunity to discuss the history of the condition, the findings in 115 cases which have come to the attention of the Correspondence Office dealing with this entity, and the results of treatment. A discussion of the suspected etiology of the condition is presented. The condition remains one of unknown etiology which can be treated by cyst evacuation or aspiration when the popliteal artery is patent and which is best treated by arterial reconstruction when the artery is occluded. The results of such treatment are good but are dependent upon technical excellence of the operative procedure.

Adolescent↗
PubMed2003

Popliteal artery injuries: the Kashmir experience.

BACKGROUND: Popliteal artery injuries pose a serious threat to limb survival. Blunt trauma appears to be associated with a higher amputation rate than penetrating trauma, probably because of the more extensive nature of the injuries. METHODS: Two hundred seventy-two cases of popliteal artery injury were studied retrospectively from 1989 to 2001, a warlike period in Kashmir. Preoperative angiography was not performed. Thirty-two percent of patients had associated venous injury and 24.6% of patients had associated bone fracture. RESULTS: Overall morbidity was 55%, with the most common complication being infection (24%). Secondary amputation had to be performed in 16 patients (5.5%). The amputation rate was not influenced by cause of injury and type of repair or the presence of venous injury, but associated bone fracture significantly increased the risk of amputation (p < 0.05). The patients who underwent repair more than 12 hours after sustaining injury had a significantly greater amputation rate (p < 0.05). CONCLUSION: Prompt resuscitation, vascularization, and proper technique appear to be the only correctable factors that improve limb salvage.

Adolescent↗
PubMed1988

Baker's cyst connected to popliteal artery cyst.

A patient with compression of the left popliteal artery by cystic adventitial disease is presented. The adventitial cyst was connected to a Baker's cyst. The patient suffered severe ischemia only after heavy exercise, because the mucous fluid of the Baker's cyst shifted into the popliteal artery cyst when the Baker's cyst was compressed. The etiology of cystic adventitial disease of the popliteal artery in this patient is discussed.

Adult↗