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PubMed2004

Expansion rates of asymptomatic popliteal artery aneurysms.

OBJECTIVES: In the absence of symptoms the decision to operate on popliteal artery aneurysms (PA) is often made on PA diameter. Little information exists on growth rate and therefore optimum scanning intervals. The aim of this paper is to define growth rate of PA managed conservatively. METHODS: A prospective study of patients with asymptomatic PA was carried out. Patients were invited for ultrasound scanning at 6-12 months intervals. Diameter changes between consecutive pairs of scans were measured. A decision to operate was made in fit patients if PA became symptomatic and/or had a diameter above 3 cm. RESULTS: Twenty-one men (24 aneurysms) with a median age of 69 years (46-86) underwent 78 scans. Sixteen PA were on the right and eight on the left. Eighteen patients had bilateral aneurysms, 15 of which were complicated on one side at presentation and were dealt with surgically on that side. The median size at first scan was 19 mm (14-36). The median time interval to the first follow-up scan was 9 months and subsequent scans were 12 months. The mean rate of expansion at aneurysm sizes below 20 mm diameter was 1.5 mm/year. PA grew by 3.0 mm/year at sizes 20-30 mm and by 3.7 mm/year at sizes >30 mm. Among the risk factors analysed, hypertension appeared to increase the risk of aneurysm growth. CONCLUSION: The expansion rate of PA increases with increasing size of the PA. This rate of growth in relation to size at previous scan and threshold diameter for intervention should be borne in mind when planning surveillance intervals.

Aged↗
PubMed1990

[Isolated stenosis of the popliteal artery after treatment with methysergide. An anatomopathologic study].

One case of isolate stenosis of the popliteal artery in a young woman is reported in this article. Since acid Methysergide maleate had been taken over a longer period, this lesion was placed into the nosological context of toxic arterial fibrodysplasia. Although such lesions usually recede at the end of treatment, the severity and abruptness of ischemia in this case led to operating the patient. This allowed an anatomopathological examination, which showed the diffusion of fibrosis into all layers of the arterial wall.

Adult↗
PubMed1995

Surgical aspects of popliteal artery entrapment syndrome: 26 years of experience with 26 legs.

The authors present their experience in diagnosis, therapy and follow up of the Popliteal Artery Entrapment Syndrome (PAES) during the last 26 years. PAES appears most frequently in young athletic male patients. From 1967 to 1993, 20 patients, 17 male (85%) and 3 female (15%), with 26 entrapment legs were treated. Average age at the time of the first symptoms was 33.5 years and at the time of diagnosis 38.5 years. Six patients suffered from PAES on both legs. In 5 of the 24 operated cases a re-operation was necessary. One case required a third operation. To reduce the postoperative complication rate, surgical technique was chosen according to the anatomical situation. If there was only slight disease of the popliteal wall, the current surgical technique consisted in decompressing the artery and replacing it in the orthotopic position through a direct entrance with the patient in the prone position. If there was severe disease of the popliteal wall, an autologous venous bypass from the popliteal artery segment I to segment III should be done with the patient supine. In our opinion, a primary catheter lysis therapy, which can be indicated for stenosed arteries, should not be done for peristenotic aneurysms. Successful therapy of PAES largely depends on early diagnosis that has been confirmed by CT scan.

Adolescent↗
PubMed1978

Endarterectomy of the popliteal artery for segmental occlusive disease.

Segmental occlusive disease though limited to the popliteal artery gives rise to significant ischemic symptoms such that surgical treatment is indicated. Endarterectomy with vein angioplasty was the primary procedure in 76 patients (79 limbs) over the past 15 years. Augmentive lumbar sympathectomy was performed in 30 patients. Endarterectomy restoration was successful in 73 patients (76 limbs). Acute postoperative thrombosis occurred in six limbs, four were restored, one survived, one underwent delayed amputation. Long term failures developed in 18 limbs, four were restored, 11 survived without further treatment, and three were amputated. All limbs were classified according to stages of outflow obstruction and extent of endarterectomy; however, there was no meaningful pattern of correlation with failures except to note that amputations occurred only in advanced stage III obstructions. Thirty-two patients (43%) were restudied by arteriography. Cumulative patency rate for 79 limbs at risk at five years was 75.6%, at ten years, 58.5%. Restoration of popliteal patency can be accomplished by endarterectomy with results comparable to femoral-popliteal saphenous vein graft for more proximal lesions. Endarterectomy affords the advantage that a bypass procedure can still be performed in most failures as the long saphenous vein, not sacrificed initially, is still available.

Adult↗
PubMedDate not supplied

[Bilateral popliteal artery aneurysm revealing an entrapment].

Popliteal entrapment syndrome is not so rare if usually researched by clinical examination. But it is very unusual to find a bilateral aneurysm when you first examine your patient. One of them was complicated by a rupture. The surgical management with bilateral venous grafts is described.

Aneurysm↗
PubMed1993

[Popliteal artery entrapment syndrome: familial occurrence].

So far only few cases of familial occurrence of popliteal artery entrapment have been reported. Such a case involving two brothers and one sister is described. Both the male subjects presented with additional patellar dysplasia and had to undergo surgical therapy. In the case of their sister a conservative treatment was sufficient.

Adult↗
PubMed1976

[Isolated obliteration of the popliteal artery. Angiographic, functional and surgical considerations].

31 patients suffering from isolated obliteration of the popliteal artery were selected for reporting from a series of 1500 peripheral angiographies. It is pointed out that the lesion is due principally to a segmentary localization of atherosclerosis. A case of adventitial cyst and one of muscular pincer syndrome have also been encountered. Attentive study of angiographic pictures showed up a number of behaviour modalities of the collateral circulation. The surgical approaches available in such circumstances are also reported.

Adolescent↗
PubMed1994

[Percutaneous transluminal angioplasty of the ilio-femoro-popliteal arteries: initial and long-term results].

The initial and long-term results of percutaneous transluminal angioplasty (PTA) were assessed in 254 atherosclerotic lesions of the ilio-femoro-popliteal arteries in 130 patients. There were 122 men and 8 women, aged 36-85 years (average, 68 years). Follow-up periods ranged from 1 to 131 months, with a mean of 42 months. PTA was performed in 6 patients in Fontaine's stage I, 112 patients in stage II, and 12 patients in stage III-IV. We reported initial success rates of 92%, 58%, 83% and 74% for iliac stenosis, occlusion, femoro-popliteal stenosis and occlusion, respectively. Overall, the initial success rate was 82% (203/247). The 5-year patency rates according to Kaplan-Meier analysis were 70%, 69% and 63% for iliac stenosis, occlusion and femoro-popliteal stenosis, respectively. In femoro-popliteal occlusion, the 1-year patency rate was 42%, which was significantly worse than that for stenosis (P < 0.01). The longest patency periods obtained were 131 months in the iliac artery, and 106 months in the femoro-popliteal artery. The recurrence rate within 6 months was significantly higher in patients with diabetes. The recurrence rate between 6 and 12 months was significantly higher in patients with poor run-off, and those of advanced age.

Adult↗
PubMed1980

Popliteal artery branches: percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty of the branches of the popliteal artery was performed in six patients, two of whom also had femoropopliteal angioplasty. Dilatation was performed with catheters ranging from 5.5 to 7 French. None of the popliteal branch dilatations was performed with an inflated balloon. Excellent dilatation, as documented by angiography and Doppler ultrasound pressure recordings, was obtained in four cases and moderate and slight improvement in one case each. Two of the four patients with excellent results had prompt healing of toe amputations and are doing well at 19 and 22 months after angioplasty. In the other two patients with excellent results, below-knee amputation was necessary despite patency of the dilated segment in one. In the other patient with initially excellent results, reocclusion occurred 4 months after angioplasty. In the patients who had moderate and slight improvement on angiography and in distal pressures, no significant clinical course change occurred. No patient had clinical deterioration after angioplasty and no significant complications occurred.

Aged↗
PubMedDate not supplied

Laser angioplasty for superficial femoral and proximal popliteal artery occlusion.

A prospective study of percutaneous laser assisted thermal angioplasty for superficial femoral and proximal popliteal artery occlusions was performed on 93 consecutive patients with a mean length of occluded segment of 7.6 cm. Technical success was achieved in 78 patients (84%). Subsequent patency or occlusion has been confirmed by duplex ultrasound scanning or arteriography. The crude patency rate for successfully recanalised vessels was 48% during a mean follow-up period of 18 months. Subsequent femoropopliteal bypass or amputation was required in 20% of these patients. Factors predictive of reocclusion were a length of occluded segment greater than 8 cm (p = 0.05) and less than two patent vessels below the knee (p = 0.005).

Adult↗
PubMed1998

Management and outcome of popliteal artery aneurysms in a New Zealand provincial centre.

BACKGROUND: The experience of management of popliteal artery aneurysms (PAA) in a provincial centre is described. METHODS: Patients were identified from vascular audit, and case notes were reviewed retrospectively. RESULTS: There were 17 patients with 23 PAA over 12 years. All patients were male, with a mean age of 73 years. Other aneurysms were present in 77% of patients, 59% had bilateral PAA and 41% had an associated abdominal aortic aneurysm (AAA). Mean follow-up was 3 years, 3 months (range, 1 month - 7 years). There were 11 acute procedures, and 12 elective. Reconstruction with bypass and ligation of the aneurysm was performed in all elective and 9/11 acute procedures. Of the 21 bypass procedures, 17 used autologous vein, three used GoreTex, and 1 composite graft. There were two PAA that were not reconstructable. All the vein grafts remained patent during the time of follow-up, but two of the three GoreTex grafts failed. Successful reconstruction was achieved in 11/12 elective and 9/11 acute cases. All grafts in the acute group remained patent during the time of follow-up (mean, 3.5 years), in the elective group 11/12 grafts (91%) remained patent (mean follow-up, 2.5 years). CONCLUSIONS: An excellent outcome was achieved in both elective and acute procedures. Autologous vein grafts appear to give better results than synthetic grafts. Due to the high incidence of multiple aneurysms, screening for other aneurysms is suggested.

Aged↗
PubMedDate not supplied

[Is percutaneous transluminal angioplasty of the femoral and popliteal arteries a justifiable procedure? A discussion in relation to 58 attempts].

Angioplasty of the femoral and popliteal arteries was attempted in 58 cases over a period of 2 years. Ideal cases for treatment by percutaneous transluminal angioplasty (PTA) are those with stenoses less than 3 cm or obliterations less than 6 cm in length where the onset was between 6 months and 2 years previously. Immediate success was obtained in 50 cases (86 patients), failures usually being observed in very advanced cases. Permeability after 2 years, by actuarial calculation, was observed in 85 p. cent of cases and there were 7 complications (12 p. cent) in the 58 patients, one of whom required urgent surgery. This method represents an alternative procedure to conventional surgical shunts in young subjects, those at high surgical risk, and those with lesions in two zones. These results illustrate the value of early diagnosis, by arteriography of the lower limbs, to detect recent lesions responding best to PTA and thus to gain time in the long and painful history of this disease.

Aged↗
PubMed1997

[Popliteal artery entrapment syndrome. Case report of an 11-year-old boy].

The popliteal entrapment syndrome arises due to a compression of the popliteal artery by tendomuscular structures often combined with an anomal position of the artery. Mostly young men are complaining of this disease. We report about an eleven-year old boy, who had an interview with us because of acute ischaemic symptoms in the left shank. We ensured a popliteal entrapment syndrome type I by Kogel. By a dorsal approach to the fossa poplitea we performed the myotomy and the restoration of the artery into the normal position. Eight month postoperative the boy is without any complaint. In doppler-scan we record an normal arterial flow.

Blood Flow Velocity↗
PubMed1988

Adventitial cystic disease of the popliteal artery: treatment by cyst removal.

Controversy still exists concerning the optimal treatment for adventitial cystic disease of the popliteal artery: complete removal of the cyst without arterectomy or arteriectomy with venous replacement. In the two cases presented here, it was possible to completely excise the cyst and to preserve a solid arterial wall despite the magnitude of lesions documented on preoperative angiograms. Good functional and anatomic outcome has been maintained for 5 and 9 years, respectively. According to the available literature on pathologic data, complete cyst excision without arterial reconstruction is often feasible. Our results, as well as those published by others, suggest that short- and long-term outcome is better after complete cyst removal without than that with arterial reconstruction. As most patients are generally young adults, cystic excision should be preferred to venous bypass whenever feasible and whenever the remaining arterial wall seems to be healthy and solid.

Adult↗
PubMed1981

[The trapped popliteal artery syndrome. About one bilateral case (author's transl)].

The authors report on a new case of trapped popliteal artery syndrome. It was bilateral and revealed on one side by acute thrombotic ischemia, leading on this occasion to discovery of the opposite trap. They insist on the extremely easy diagnosis based on a dynamic examination of the limb. The distal pulses must be felt in intermediary position, then after tensing of the gastrocnemia by dorsiflexion of the foot and hyper extension of the knee. Blood velocity measurement by Doppler probes and bifemoralangiography, both dynamic, must precede imperative surgery.

Acute Disease↗
PubMed1994

The popliteal artery as inflow for distal bypass grafting.

OBJECTIVE: To examine the patency and limb salvage characteristics of the popliteal-distal artery saphenous-vein bypass in patients with minimal superficial femoral artery disease. DESIGN: A retrospective review. SETTING: A tertiary care university hospital in the Chicago, Ill, metropolitan area. PATIENTS: Fifty-two popliteal-distal artery saphenous-vein bypasses for occlusive disease were performed in 51 patients between 1980 and 1993. The mean age at operation was 62 years (range, 37 to 85 years); 34 patients (67%) were male, 45 (88%) were smokers, 44 (86%) had diabetes, and 34 (67%) had coronary disease. The primary indications for operation were gangrene (21 patients [41%]), ulcer (15 patients [29%]), and rest pain (16 patients [31%]). INTERVENTION: Bypass of diseased arterial segments was performed using popliteal-distal artery saphenous-vein bypass grafts. The proximal anastomoses were either to the above-knee popliteal artery (50%) or to the below-knee artery (50%), with outflow to tibial (79%) or pedal vessels (21%). MAIN OUTCOME MEASURES: Overall patient survival, limb salvage, and primary and secondary graft patency. RESULTS: Follow-up of graft patency ranged from 1 day to 11 years (mean follow-up, 2.7 years). The perioperative mortality was 2% and life-table survival was 94% at 1 year, 68% at 5 years, and 50% at 10 years. Primary patency was 90% at 1 month, 82% at 1 year, and 75% at 5 years. There were 14 primary graft failures, only two of which could be traced to progression of proximal disease; five failures occurred less than 30 days after operation. Six of these 14 patients contributed to secondary patency that was 96% at 1 month, 90% at 1 year, and 79% at 5 years. Limb salvage was 96% at 1 month, 90% at 1 year, and 87% at 5 years (seven major amputations were required). No significant differences in patency, limb salvage, or survival were observed on comparison of the level of the proximal or distal anastomosis, type of vein graft, or presence of comorbidities. CONCLUSIONS: We conclude that popliteal-distal artery bypass provides excellent patency and limb salvage for patients with severe ischemia. The use of a popliteal artery inflow source is preferable in patients with a paucity of venous segments since progression of proximal disease rarely leads to graft failure.

Adult↗