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PubMed1993

[A rare cause of claudication in a young person: cystic adventitial degeneration of the popliteal artery. Case study].

The authors report a new case of cystic adventitial disease of the popliteal artery in a 43 year old woman. It is a rare disease in young people which concern essentially the adventitium of the arterial wall. When echographic aspect mimics thrombosed aneurysm aspect, the diagnostic is done by arteriography. Two surgical technics are convenient: the adventitiotomy and the venous bypass.

Adult↗
PubMed1990

[Cystic adventitional degeneration of the popliteal artery: preoperative diagnosis using imaging technics].

The presented case of cystic adventitial disease of the popliteal artery as a rare cause of intermittent claudication shows the value of modern imaging in establishing the preoperative diagnosis. Besides the characteristics of real-time ultrasound and computerised tomography, the results of angiography and especially functional angiography are discussed and their value towards differential diagnosis is pointed out.

Adult↗
PubMed1982

Adventitial cystic disease of the popliteal artery in Brazil: additional data on the geographical distribution of the disease.

Adventitial cystic disease of the popliteal artery is an uncommon condition. Previous reports show a grouping of cases of this disease in Europe and Australasia. With the purpose of widening the knowledge of the geographical distribution of the disease, 3 cases from Brazil are described, and reference is made to 1 previously reported. It is suggested that not recognizing or not reporting the disease could be the cause for this grouping and that the number of diagnosed cases may increase in different parts of the world due to the greater awareness of the disease.

Aged↗
PubMedDate not supplied

A new syndrome: the pseudo-entrapment of the popliteal artery and tibial nerve.

The pseudo-entrapment syndrome is caused by kinking of the popliteal artery and vein, and/or of the common tibial nerve, and occasionally of the common fibular nerve. The clinical symptoms are similar to the symptoms found in the entrapment syndrome. The kinking in pseudo-entrapment is caused by one or more transverse fibrous bands, resulting in calf pain and distress. The assessment of this new syndrome is made only by Doppler ultrasound being adequate and accurate. The treatment is surgical consisting in division and resection of the fibrous bands. The results achieved early and late postoperatively are excellent. This syndrome is till now not defined, disregarded and underdiagnosed, so that it is justified to consider it as a new syndrome.

Female↗
PubMed1994

Acute treatment of penetrating popliteal artery trauma: the importance of soft tissue injury.

During a 20-year period from 1973 to 1992, 109 patients underwent early operation for acute popliteal artery trauma. Clinical variables were analyzed for their association with amputation. Gunshot wounds accounted for the majority of injuries (73%), followed by shotgun wounds (18%), stab wounds (6%), iatrogenic injuries (2%), and lacerations (1%). Fasciotomies were performed selectively in 41% of patients. Seven patients (6%) lost the injured extremity despite arterial repair. The mean time from injury to arterial repair was not significantly different for patients with or without subsequent amputation (8.6 +/- 3.6 and 9.7 +/- 7.4 hours, respectively; p = 0.69). Delay in diagnosis longer than 6 or 12 hours after the injury did not increase the risk of amputation. Other factors not associated with limb loss were preoperative ischemic neurologic deficit or compartmental hypertension, concomitant fracture, and popliteal vein injury. Severe soft tissue injury (p < 0.0001) or postoperative wound sepsis (p < 0.0001) substantially increased the risk of amputation. Delayed fasciotomies were uncommon (4%) but were associated with a significantly increased risk of amputation (p < 0.0001). Vein grafting for arterial repair (p = 0.0017) and shotgun injuries (p < 0.0001) were associated with amputation to the extent that they were related to severe soft tissue injury. The degree of soft tissue trauma and subsequent infection of devitalized tissue limits the success of popliteal arterial repair. Changes in the mechanism of trauma, liberal use of four-compartment fasciotomies, and aggressive management of soft tissue injury resulted in a significant decline in the amputation rate from 21% (4/19) in the first 5 years to 0% (0/39) in the last 5 years of the study.

Adolescent↗
PubMed1994

Popliteal artery aneurysms: the risk of nonoperative management.

To evaluate the risk of nonoperative management of popliteal artery aneurysms (PAAs), a retrospective cohort study of 106 consecutive patients (103 males and 3 females) with PAAs seen between January 1, 1980, and December 31, 1985, was performed. The mean age was 70.5 years (range 50 to 90 years). The 106 patients with 161 PAAs were followed for a mean of 6.7 years (range 3 days to 12.1 years). Follow-up was complete in 91.5% (97/106) of the patients. PAA was confirmed by ultrasonography in 124 limbs (77%), arteriography only in 7 (4.3%), and physical examination only in 32 (19.9%). Fifteen limbs presented with acute symptoms, 52 with chronic symptoms, and 94 were asymptomatic. Five of the 15 limbs with acute symptoms (33%) underwent amputation (4 primary, 1 secondary). PAAs in 23 of the 52 limbs with chronic symptoms were repaired; 2 limbs required amputation (8.7%). Twenty-seven of the 94 asymptomatic limbs were repaired initially; 1 required amputation (3.7%). The remaining 67 asymptomatic limbs were initially managed nonoperatively. Amputation was required in 3 of 67 limbs (4.4%), 1 with acute symptoms and 2 with chronic symptoms, all of which had undergone attempted repair. Symptoms (3 acute, 9 chronic) eventually developed in 12 (17.9%). At least one of three risk factors (size > 2 cm, thrombus, and poor runoff) was initially present in 11 of 12 limbs (91.7%) compared with 9 of 24 control limbs (37.5%) that remained asymptomatic (p < 0.05). Amputation rates in symptomatic patients with PAAs continues to be high. In patients with asymptomatic PAAs, aneurysm size > 2 cm, thrombus, or poor runoff predicted the development of symptoms. PAA patients with any of these factors should undergo elective repair, even asymptomatic patients who have a reasonable chance for long-term survival.

Aged↗
PubMed1995

Acute popliteal arterial injury: the role of angioscopy.

Accurate identification of arterial injury in the emergency setting constitutes one of the essential prognostic factors in patients presenting with acute popliteal arterial injury (APAI). The modalities of angioscopy performed intraoperatively by the vascular surgeon, including the details of how angioscopy can contribute to therapeutic decisions in this setting, are presented. Between June 1987 and August 1993, 26 patients presenting with 27 APAIs (one patient had a bilateral APAI) were treated at our institution. Eighteen (67%) lesions were due to closed trauma, three (11%) to shotgun pellets, three (11%) to knife wounds, two (7%) to iatrogenic wounds, and one (4%) to a bullet wound. Between June 1987 and January 1992 (group I, n = 20), treatment consisted of 15 (75%) saphenous vein bypasses and five (25%) local repairs. Pre- or intraoperative arteriograms were obtained in 14 (70%) cases. Three (15%) major amputations were required after popliteal reconstruction. Between February 1992 and August 1993 (group II, n = 7), two (29%) saphenous vein grafts and five (71%) local repairs were performed after routine intraoperative angioscopy. Arteriograms were obtained in six (86%) instances. No amputations were necessary in this group. As a complement to arteriography, intraoperative angioscopy can determine the extent and number of injuries, provides direct visualization of the intima of the entire femoropopliteal artery, even when the latter is obscured by thrombus, and ensures a final control of popliteal artery repair at completion. After angioscopy, local repair was possible more often (71% vs. 25%, p = 0.03) and treatment was associated with a better functional result (0% vs. 15% amputation rate, p = 0.04) in group II.

Adolescent↗
PubMedDate not supplied

The role of popliteal artery embolectomy in the management of acute lower limb ischemia: our experience.

INTRODUCTION: The Authors report their experience in the management of acute lower limbs ischemia through distal popliteal artery approach. PATIENTS AND METHODS: Five popliteal embolectomy through a medial approach were performed; in one patient a posterior approach was carried out. Patients were included in two groups on the basis of ischemia duration: group A<6 hours (3 patients) and group B>6 hours (3 patients). Colour-duplex scan was performed in all the patients The arteriotomy was closed with interrupted 7/0 monofilament polypropylene sutures. RESULTS: There were no peri-operative deaths. The primary limb salvage rate was 83.3% (5 patients). In one case (16.7%) a major amputation was performed. In one case (16.7%) a drop foot occurred. CONCLUSIONS: The popliteal embolectomy is followed by excellent results and should be consider prior to thrombolysis or bypass graft revascularization. An appropriate use of duplex scan and a medial approach can lead to an high successful rates in terms of limb function and limb salvage also in cases with delayed ischemia.

Acute Disease↗
PubMed2006

Results of different operative procedures for patients with popliteal artery aneurysms.

BACKGROUND: Long term results of four different operative procedures for the treatment of popliteal artery aneurysms were investigated either performed by short venous or segmental alloplastic interpositions or long femoro-popliteal below the knee bypass using alloplastic grafts or autologous vein. PATIENTS AND METHODS: 47 patients treated for 50 popliteal aneurysms (mean diameter +/- SD: 3.5 +/- 1.1 cm) were analyzed (follow-up: 40.2 +/- 4.9 months). RESULTS: Primary patency rate was 78% and secondary patency rate was 86% at 5 years. Frequency of operative reinterventions was higher in patients treated for acute ischemia and in patients treated with alloplastic interpositions or alloplastic bypass (p = 0.026). Secondary patency rates were higher in patients treated with autologous venous interpositions or venous femoro-popliteal bypass (p = 0.022). Times of secondary vascular patency were significantly shorter for patients treated with short alloplastic interpositions in comparison to long alloplastic femoro-popliteal bypass procedures, short venous interpositions or long venous bypass operations (p = 0.018). CONCLUSIONS: For the treatment of patients with popliteal aneurysms autologous venous interposition is therefore recommended or as an alternative venous or alloplastic femoro-popliteal below the knee bypass.

Amputation, Surgical↗
PubMed1989

[Cystic adventitial disease of the popliteal artery. Report of 2 cases and review of the literature].

Two cases of cystic adventitial degeneration of the popliteal artery are reported and aetiopathogenetic theories, diagnosis and treatment discussed. One of the cases presented is of special interest because, at surgery, it was possible to observe the relationships of the artery with the articular capsule of the knee through a genicular vessel which, when sectioned, showed an exit of mucinous material the equivalent of that contained in the vasal cyst. This observation gives even more credence to the so-called "articular" aetiopathogenetic theory. The two cases were treated surgically with resection of that segment of the artery and contralateral saphenous vein graft giving an excellent short-term and long-term result and protecting from recurrences.

Adult↗
PubMed2002

Prospective study of 36 patients with 46 popliteal artery aneurysms with non-surgical treatment.

BACKGROUND: There is a lack of prospective studies with popliteal aneurysms (PAA) < 2 cm and the very few information about the natural cause of the disease. PATIENTS AND METHODS: Between 1995 and 2000 46 patients having 65 popliteal artery aneurysms have been examined. The mean diameter was 1.9 cm (0.8-4 cm). In 41% of the cases PAA were bilateral, additional extrapopliteal aneurysms were found in 37%. The PAA was occluded in 8 patients at the initial examination (mean diameter 2.4 cm: 1.4-4 cm). One of these patients had to be amputated (long-term diabetes, dialysis and severe generalized peripheral arteriosclerosis). Since no information could be obtained from two patients, it was possible to prospectively monitor 36 patients with 46 PAA (30 m, 6 f) over a period of 2.5 years. 19 patients were treated with platelet inhibitors, 16 with coumarin and one refused any thromboembolic prophylaxis. The patients were examined every year by telephone interview and duplexsonography. RESULTS: During the monitoring period there occurred two complete occlusions and one distal arterial progression, while 2 patients died, but no amputation. The total complication rate was 6.5% with a higher incidence in PAA > 2 cm of diameter (14.2 vs. 3.1%). All complications were found in PAA with mural thromboses. Coumarin seems to be superior platelet aggregation inhibitors with a complication rate of 0% vs. 14.3%. The mean increase in diameter during follow-up was dependent on PAA size, 1.5 mm/year for PAA > 2 cm vs. 0.7 mm/year for PAA < 2 cm. CONCLUSION: This prospective study emphasises the necessity of a prophylactical surgery in patients with an aneurysm diameter > 2 cm. In view of the low rate of complications of the natural course of PAA (6.5% of all PAA or 14.2% for PAA > 2 cm/2.5 years), the bypass surgery should be performed by an experienced vascular department. Patients with PAA < 2 cm or patients with contraindication for peripheral bypass should receive anticoagulation.

Adult↗
PubMed1994

Penetrating injuries of the popliteal artery: the Baragwanath experience.

This study describes the management of 43 patients with penetrating injury of the popliteal artery. Of these patients, 33 (76.5%) had bullet wounds, four patients (9.5%) pellet wounds and 6 (14%) knife wounds. Patients with 'hard' signs of arterial injury underwent exploration without preoperative angiograms. There were no negative explorations. Patients with only 'soft' signs of arterial injury underwent preoperative angiograms. Of this group, 75% had positive angiograms and underwent exploration. There were no false-positive or false-negative preoperative angiograms in the group of patients with 'soft' signs in this study. Definitive orthopaedic management of associated fractures followed vascular reconstruction. There was no difference in the short-term patency of autologous saphenous vein graft as against PTFE grafts. Fasciotomy was performed on patients who had arterial and venous injury or presented late. Overall amputation rate was 14% and for bullet injuries 18%.

Adolescent↗
PubMed1999

[A case of thrombosed popliteal artery by method of endovascular pulse spray thrombolysis in the process of multiple fractures of tibia].

A case of team-treated thrombosed popliteal artery caused by blunt limb trauma with open tibia fracture is presented. Thrombosed artery was treated by endovascular pulse-spray method using Angiomed catheter. Implementation of this method allowed us to dissolve thrombus and to retrieve arterial circulation in the limb. In our opinion this procedure was an alternative for traditional surgery. After revascularisation of the limb orthopedic operation on fractured bones was performed using Zespol technique.

Aged↗