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PubMedDate not supplied

[The popliteal artery entrapment syndrome].

The authors are presenting 8 patients with 9 cases of popliteal artery entrapment syndrome. There were one female, and 7 male patients with average age of 36.4 (25-54) years. Six cases were manifested with acute, 2 with chronic foot ischemia, while one case was asymptomatic. For diagnosis a combination of Doppler sonography and transfemoral angiography, was used. Eight cases were operated using posterior, while in one medial approach to the popliteal artery. The types I and IV of the popliteal artery entrapment syndrome were found in one case, type II in two cases, type III in 4 cases, while in one case a type of syndrome had not to be identified. During the operation the resection of the anomalous muscle and reconstruction of the popliteal artery, were done in 8 cases. In one case muscle resection or arterial reconstruction, were not necessary. The early potency rate and limb salvage, were 100%, while long term potency rate after mean follow up period of 6.3 years was 83.5%. The acute or chronic foot ischemia in health, young persons without typical atherosclerotical risk factors, suggests on popliteal artery entrapment syndrome.

Adult↗
PubMedDate not supplied

Superficial femoral artery as inflow for bypass to the proximal popliteal artery.

We have obtained long term follow-up on 58 patients in whom the superficial femoral artery was used as a donor site for bypass to the proximal popliteal artery. The indication for the reconstructive procedure was intermittent claudication 36%, rest pain 34%, and gangrene 26%. All patients had angiographic evidence of a patent proximal superficial femoral artery and many had relative indications for short bypass such as limited saphenous vein availability or compromised medical condition. There was a cumulative patency rate of 79% by life table method for the series with a six year follow-up. We have observed that the superficial femoral artery is a satisfactory inflow site for proximal popliteal bypass grafts in selected patients. The procedure can maximize use of a limited segment of vein with minimal operative time and morbidity. Inflow stenosis can be revised or long bypass procedures can be offered in the event of graft failure.

Adult↗
PubMedDate not supplied

Importance of the arteriographic anatomy of the descending genicular artery and sural arteries in patients with atherosclerotic occlusion of the popliteal artery.

Bypasses to the descending genicular artery (DGA) or the medial sural artery (MSA) have been performed with acceptable rates of midterm success. The arteriographic appearance of the DGA, the MSA, and the lateral sural artery (LSA) was described and the applicability of bypass to these vessels was investigated. The arteriograms of 45 patients who had occlusion of the below-knee popliteal artery were analyzed to determine the presence, dominance, and extension of collaterals for each perigeniculate branch, which were used to assess the applicability of a perigeniculate bypass. A dominant perigeniculate artery was found in 26 arteriograms and corresponded to 13 DGAs, 9 MSAs, and 4 LSAs. Of 14 applicable perigeniculate bypasses, 2 would be an obligatory bypass and 12 would be an alternative to a conventional infrapopliteal bypass. Although rarely an obligatory solution, a bypass to a perigeniculate branch artery represents a valuable alternative.

Arterial Occlusive Diseases↗
PubMed1984

Popliteal artery injury in Kuwait.

While there is an abundant literature on popliteal artery injury secondary to penetrating trauma, few reports deal with popliteal artery injury caused by severe blunt trauma with or without fracture. Eight cases of popliteal artery injury are described. Seven of the patients had sustained blunt trauma, usually resulting also in damage to bone and soft tissues. The popliteal vein was involved in five of the injuries. The time lag between causal trauma and vascular repair averaged 25 hours. Delay was due mainly to failure to consult the vascular surgeon at an early stage. Leg amputation was necessary in two cases. Two patients died. The importance of early recognition of the vascular injury and appropriate surgical measures was illustrated in this small series of patients from a developing Middle Eastern country. Adequate fasciotomy, venous repair, use of intraoperative Doppler and repeated postoperative débridement are discussed in connection with management.

Adult↗
PubMed2004

Popliteal artery pseudoaneurysm caused by osteochondroma.

A 49-year-old man with asymptomatic osteochondroma was found to have a pseudoaneurysm of the left popliteal artery. An angiography showed a popliteal artery pseudoaneurysm adjacent to a femoral osteochondroma. The osteochondroma was excised and the popliteal artery containing the tear was also excised by end-to-end anastomosis. Vascular complication of osteochondroma is extremely rare. Paul reported the first case of a popliteal artery pseudoaneurysm due to osteochondroma in 1953. A computerized literature search revealed 40 additional cases reported in English, providing sufficient detail to allow comparison. The average age of the patients was 22.6 years (range 9-51) and most cases identified involved males (30 of 41, 73%). Most pseudoaneurysm were located in the popliteal artery. This report discusses the authors' experience with this disorder and a review of the literature in English.

Aneurysm, False↗
PubMedDate not supplied

Bilateral adventitial cystic disease of the popliteal artery: a case report.

Adventitial cystic disease (ACD) of the popliteal artery is an uncommon vascular condition of unknown etiology. In the present case report, we describe a case of bilateral ACD of the popliteal artery in a 58-year-old male. To the best of our knowledge, this is the first case of bilateral ACD of the popliteal artery reported in the literature.

Angiography, Digital Subtraction↗
PubMed1991

[Self-expanding endoprostheses. Applications in iliac and femoro-popliteal arteries].

Vascular endoprosthesis are aimed at optimizing the results of angioplasty. They are metallic cylinders, most often meshed, laid against the wall of the vessel and progressively incorporated into the intima by endothelial coverage. Experimental studies show that this incorporation occurs within a few weeks. The prosthesis are either self-expanding or mounted on a dilatation balloon. Their aim is to restore a good-quality caliber by smoothing the parietal irregularities that were frequently encountered after dilatation. They are a true parietal prop, inserted into the arterial lumen through a percutaneous approach. The middle-term results of iliac and femoropopliteal implants are very encouraging, and they suggest that this technique may be a very useful complement to transluminal angioplasty in cases of poor results or recurrence. The insertion of an endoprosthesis also allows to extend the indications of transluminal angioplasty to cases that had been regarded as hardly favorable so far: long, irregular stenosis, iliac obliteration, etc.

Blood Vessel Prosthesis↗
PubMed2000

Gunshot injuries of the popliteal artery.

BACKGROUND: Guidelines for the management of popliteal artery trauma emanate mainly from military experience. This study was undertaken to describe the management of popliteal injuries in a civilian vascular surgical unit with a large trauma workload. METHODS: A retrospective review of records of patients treated between 1983 and 1997 was undertaken. RESULTS: Some 117 popliteal artery gunshot injuries were treated (83 low velocity, 16 high velocity, 18 shotgun). Associated fractures occurred in 44 patients and 40 had popliteal vein injuries. Treatment of the arterial injury included vein graft interposition in 71, primary reanastomosis in 19, prosthetic graft interposition in four, lateral suture in one, vein patch in one and ligation in one patient; 84 fasciotomies were performed. No perioperative deaths occurred. There were 20 primary and 14 secondary amputations. Factors associated with amputation were high-velocity injuries, delay in revascularization in excess of 7 h, arterial transection, associated fracture, and compartment syndrome or muscle infarction. CONCLUSION: Civilian popliteal gunshot injuries are attended by a high amputation rate. Prompt resuscitation and revascularization appear to be the only correctable factors that may improve limb salvage rates.

Adolescent↗
PubMed2001

[The popliteal artery entrapment syndrome--personal experience].

OBJECTIVE: In a retrospective study we analyze 5 patients with popliteal artery entrapment syndrome who were treated since 1999 to 2000 in our department. METHODS AND RESULTS: 5 patients were found to have popliteal vascular entrapment during a two-year period. From the total number of 5 patients, we performed surgery in 3 patients (5 operations). One patient rejected proposed surgical therapy, in another case the morphological lesion of the popliteal artery was not suitable for revascularisation. 3 patients underwent interposition of the diseased popliteal artery using a venous graft from a dorsal approach. Twice the decompression (myotomy) of the medial head of gastrocnemius muscle was sufficient. The study group is included in our follow up programme (median follow up 12.8 months, range from 3 to 24 months), primary and long term patency has been 100%. RESULTS: On the basis of our experience, we advice total replacement of the diseased popliteal artery. A dorsal approach (Hamming's "S" shaped incision) with interposition of the popliteal artery with autogenous venous graft, end to end anastomosis on both sides, seems to be the optimal solution. In case, the arterial wall is not irreversibly changed, surgical decompression (myotomy) is sufficient to prevent the development of symptomatic disease, also using the dorsal approach.

Adult↗
PubMed1979

Remote bypass grafts for managing infected popliteal artery lesions.

Infected false aneurysms of the popliteal artery may complicate vascular repairs for trauma or primary arterial disease. Adequate debridement and drainage are necessary if the limb is to be salvaged, but direct arterial grafting through the infected area cannot be performed safely. Vascular reconstruction can be accomplished by performing a femoropopliteal or iliopopliteal bypass through a lateral approach, then the infected artery can be removed safely through separate incisions. This technique was used successfully in managing four patients with infected popliteal artery pseudoaneurysms.

Adult↗
PubMed1990

Popliteal artery entrapment syndrome.

The purpose of this article was to describe popliteal artery entrapment syndrome, which is a cause of intermittent claudication in a young person, and to illustrate the importance of early diagnosis for successful treatment of this entity. A case report of a 28-year-old man with popliteal artery entrapment syndrome is presented. This patient had a classic history of calf pain that worsened with walking and was relieved by rest, running, or bicycle riding. Physical examination revealed evidence of ischemia in the distal extremity, and arteriography demonstrated signs of chronic occlusive disease. Early treatment might have included surgical release of the popliteal artery and arterial grafting. Due to extensive vascular disease, grafting was not possible and a below-knee amputation was performed. It is therefore essential to diagnose popliteal artery syndrome early for appropriate management.

Adult↗
PubMed2006

Popliteal artery branching patterns -- an angiographic study.

AIM: To analyse the variations in branching patterns of the popliteal artery and infrapopliteal vessels using angiography. MATERIALS AND METHODS: Femoral angiograms of 1037 lower limbs in 568 patients were examined to assess the popliteal artery branching pattern. Variations of the infrapopliteal vessels supplying the foot were assessed in 662 limbs from the same cohort of patients. RESULTS: Nine hundred and forty-one (90.7%) limbs had the usual branching pattern with anterior tibial artery (AT) arising first followed by the tibial-peroneal trunk (TPT), which then gives rise to the posterior tibial (PT) and peroneal (PR) arteries. Variations in popliteal branching pattern were seen in 96 (9.3%) limbs. The commonest variation is high origin of the AT in 47 (4.5%) limbs or trifurcation of the popliteal artery in 33 (3.2%) limbs with AT, PT and PR arising together with no true TPT. The course of AT with high origin either anterior or posterior to popliteus was almost equal [25 (2.4%) or 22 (2.1%) limbs, respectively]. Eleven limbs (1.1%) had high origin of PT and two (0.2%) had a high origin of the PR. Six hundred and fifty-five (99%) limbs had normal infrapopliteal vessels. Seven (1%) had hypoplasia-aplasia of the infrapopliteal vessels. Five (0.8%) limbs had a hypoplastic PT with the remaining 2 (0.2%) having either a hypoplastic-aplastic AT or hypoplasia-aplasia of both AT and PT. CONCLUSION: Variations in the branching of the popliteal artery occur in about 10% of patients. Knowledge of these variations is important because of the potential consequences for the management of peripheral vascular disease.

Cohort Studies↗
PubMed1992

Popliteal artery entrapment syndrome: implications for nursing care.

Popliteal artery entrapment syndrome is an extremely rare phenomenon, with only 249 cases in the English literature over the past 30 years. Obstruction of the popliteal artery caused by abnormal anatomic development results in diminished blood supply to the extremity. Unlike more common vascular problems, this syndrome often produces claudication and symptoms of arterial insufficiency in young, healthy, even athletic individuals with no other apparent vascular risk factors. Accurate assessment and monitoring are critical in identifying this syndrome, minimizing complications, and preventing long-term adverse effects on activities of daily living.

Activities of Daily Living↗
PubMed2006

[Trauma of the popliteal artery. Twenty three patients treated during a 27-year-period].

INTRODUCTION: Trauma of the popliteal artery is a rare event. During a period of 14 years, only 59 cases were registered in Denmark in the national register Karbase. There are several pitfalls in the management of popliteal artery lesions which may lead to an increased risk of amputation. This article analyses our own results and discusses selected topics concerning the management of popliteal artery injuries. MATERIALS AND METHODS: The records of 23 patients treated for injury of the popliteal artery over a 27-year period were reviewed. A follow-up investigation was performed. The patients' Doppler pressure was measured. RESULTS: There were three (13%) amputations. At the time of follow-up, 5 of the patients were dead; 1 person was living abroad. Of the remaining 17 patients, 15 had no vascular symptoms; 2 patients had been amputated initially, and 1 patient had been treated conservatively. DISCUSSION: Management of a popliteal artery injury can be difficult and requires an experienced approach. Our results reveal excellent long-term patency of the vascular reconstruction with the saphenus vein. Furthermore, amputation is almost always due to major soft tissue injury or delayed surgical intervention. The amputation rate of 13% in this material is in line with that in the literature. We recommend that every patient suffering from major trauma of an extremity have a Doppler pressure measurement performed and registered during the initial evaluation in the casualty department.

Adolescent↗
PubMedDate not supplied

Civilian popliteal artery trauma.

An 18 year experience involved 36 civilian popliteal artery injuries is described. There were no operative or hospital deaths and the amputation rate was 3.6%. Penetrating traumas accounted for 30.6% and blunt traumas for 69.4%. In 20 patients (55.5%) the popliteal artery injury was associated with fracture and/or dislocation of the long bones and/or the knee joint. The average ischaemic time was 7.3 hours and postoperative angiography was performed in 25 patients (69.4%). Surgical reconstruction of the popliteal artery was accomplished by interposition or bypass of autogenous saphenous vein graft in 29 (80.5%), by saphenous vein patch in 5 (13.9%) and by primary end-to-end anastomosis in 1 (2.8%) and by PTFE prosthesis in 1 patient (2.8%). In all cases with bone fracture and/or dislocation bone stabilization was followed by the vascular procedure. The average time of follow-up was 76 months, 28 patients could be evaluated in the postoperative study: in 25 (89.2%) the reconstruction was patent, in 3 (10.8%) occluded. In 13 patients (46.4%) there was a complete success, 7 had a nerve deficit (25.0%), 3 had a claudication (10.7%), in one patient an amputation was necessary (3.6%) and 4 (14.3%) suffered from miscellaneous skeletal problems. Of the 36 patients originally operated, 29 (80.5%) received anticoagulant therapy for at least one year.

Accidents, Traffic↗
PubMed2000

Effect of intermittent pneumatic foot compression on popliteal artery haemodynamics.

PURPOSE: the aim was to investigate the effect of intermittent pneumatic foot compression (IPC(foot)) on popliteal artery haemodynamics in normal individuals and in patients with intermittent claudication due to peripheral vascular disease (PVD) (Fontaine stage II). MATERIAL AND METHODS: popliteal artery volume flow [vFl], pulsatility index [PI], mean velocity [mV], peak systolic [PSV] and end diastolic velocity [EDV], in 25 limbs of 20 normal subjects and 40 limbs of 32 stable claudicants were obtained in the sitting position before, during and within 30 seconds after the application of IPC(foot)(applied pressure: 120 mmHg; inflation time: 3 seconds; deflation time: 17 seconds) using colour-flow duplex imaging (CFDI). The reproducibility of flow velocity estimations using CFDI in the horizontal [hor] (recovery) and sitting [sit] positions was evaluated in 20 limbs of normal controls and 20 limbs of claudicants. RESULTS: popliteal artery vFl, mV, PSV and PI measurements were performed with a coefficient of variation (CV) of less than 14.6% among claudicants and of less than 13.3% in normal subjects. EDV is the least reproducible parameter with an overall CV range of 10.2-21.5% in normal controls and 9.1-18.6% in arteriopaths. On application of IPC(foot)popliteal artery vFl increased by 111% in the control group (p<0.001) and by 51% in the claudicants (p<0.001). Within 30 seconds of the cessation of pump action flow decreased significantly in both groups (p<0.001), but maintained a significantly higher level than that at baseline (p<0. 001, in both groups). The mV, PSV and EDV showed a similar pattern of significant changes. Both in normals and claudicants, the PI decreased with IPC(foot)(p<0.001) and increased post-compression; however, it was significantly lower than baseline (p<0.005) within 30 seconds of impulse delivery. CONCLUSIONS: current CFDI technology enables a reproducible estimation of popliteal artery flow velocities. IPC(foot)can significantly augment arterial calf inflow on an acute basis both in normals and claudicants. The increase of EDV and decrease of PI indicate that attenuation of peripheral resistance to flow is the main mechanism underlying the popliteal artery vFl enhancement on application of IPC(foot). Prospective trials on the long-term effect of IPC(foot)in the management of patients with PVD are indicated from the results of this study.

Adult↗