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[Epithelioid hemangioma of the popliteal artery].

We report the case of a 37-year-old patient with an epithelioid haemangioma arising from the third segment of the popliteal artery and the tibio-peroneal trunk. As far as we know this is the first description of this tumour originating in an artery of this order. One year after excision of the tumour mass and vascular reconstruction the patient has recovered and shows no evidence of recurrence. Clinical manifestation and morphological characteristics of this rare lesion are described in this article.

Adult↗

Endothelial function of the popliteal artery in patients with coronary artery disease.

Coronary artery disease (CAD) is associated more closely with atherosclerosis in the popliteal than in the brachial artery. This case-control study aimed at clarifying whether endothelial dysfunction of patients with CAD can be detected non-invasively in the popliteal artery by means of ischemia-induced flow-mediated dilation (FMD) and cold pressor reaction (CPR), and how it compares with the brachial artery. We further investigated a new mode of evaluation of the CPR. Eleven cases with CAD were compared with 16 matched healthy controls. Popliteal and brachial arterial diameter was monitored by ultrasound for 20 min following ischemia and cold pressor. For CPR, the difference between maximum and minimum diameter was defined as maximum vasomotion. In the popliteal artery, maximum vasomotion and FMD were significantly smaller in cases than in controls, the difference being more pronounced than in the brachial artery, where only maximum vasomotion was significantly smaller. After exclusion of current smokers, only the difference in maximum vasomotion of both arteries remained significant. We conclude that maximum vasomotion may be more sensitive for detection of endothelial dysfunction than FMD. Endothelial dysfunction in patients with CAD is more pronounced in the popliteal artery than in the brachial artery.

Adult↗

CryoPlasty therapy of the superficial femoral and popliteal arteries: a single center experience.

Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.

Aged↗

Popliteal artery perforation during low dose intra-arterial streptokinase infusion.

There has been a recent increase in the use of low dose intra-arterial streptokinase infusion for the management of patients with acute peripheral arterial occlusions. Though serious complications using this technique occur less frequently than when using systemic thrombolytic therapy, a case is reported where the catheter used to infuse streptokinase perforated the popliteal artery 36 hours after the infusion commenced. The use of softer arterial catheters and restriction of patient movement where possible may prevent the recurrence of this previously unreported hazard.

Catheterization↗

[Popliteal artery thrombosis from an osteochondroma of the upper end of the tibia. Apropos of a case].

A rare case of thrombosis of the popliteal artery due to an exostosis of upper end of tibia is reported. It is rare for exostoses to develop at the upper metaphysial region of the tibia, rare fore vascular complications to develop and particularly rare for these to consist of thromboses. This lesion is a differential diagnosis in young adults with lower limb ischemia. Follow up of these exostoses should be by Doppler, after dynamic arteriography to serve as a reference. Surgical treatment should be adapted to the degree of functional disability and the course of the exostosis or the complications it provokes.

Adult↗

Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee.

The authors have studied, on the basis of purely radiologic data, the modifications of the popliteal arterial axis during flexion of the knee. They note the appearance in the sagittal plane of very marked flexures of the upper part of the artery, while the lower part describes a harmonious curve. These modifications take place between two fixed points: a cranial fixed point, represented by the origin of the descending artery of the knee, and a caudal fixed point represented by the origin of the anterior tibial artery. The pathologic importance of these modifications of the course of the artery should not be underestimated when obtaining revascularization by means of an arterial prosthesis.

Humans↗

Popliteal artery pseudoaneurysm following arthroscopy.

An 18-year-old male presented with left foot ischemia secondary to emboli from a pseudoaneurysm of the left popliteal artery. His past history was significant only for two arthroscopies of his left knee. After evaluation, the patient was successfully treated with obliteration of the aneurysm and a reverse saphenous vein bypass graft.

Adolescent↗

[Musculotendinous pressure on the arteries of the knee observed in a patient with obstructive entrapment syndrome of the popliteal artery and vein].

The knee artery entrapment is a consequence of congenital anatomical anomaly. As only a relatively small number of cases of this type of disease is quoted in medical literature it would appear to occur in only 0.4 percent of patients having calf claudication and more especially in youthful persons. It is possible that some patients being treated in our hospitals for other diagnosis do in fact belong to this group. It is difficult to distinguish the neglected cases of artery occlusion from some of other etiology. Angiographic examinations should be made immediately on the young patients having calf claudication and surgery to be effected in such cases. Extraordinary results are obtainable. A patient suffering from both artery and vein entrapment syndrome is presented. Subjective disturbances proved to be similar although patho-morphological changes were more visible on the right side. Histological section of dissected artery shows typical abnormal muscular arrangement.

Adult↗

Popliteal artery entrapment syndrome with distal embolization. A report of two cases.

The popliteal vascular entrapment syndrome has been recognized as a cause of arterial occlusion in young males for several decades. The ischemia is usually caused by thrombosis of the popliteal artery due to intimal trauma or aneurysm formation. Distal embolization to the tibial arteries and to the foot arch and digital vessels is common but is not emphasized in the literature. This distal embolization may precipitate severe ischemia which may preclude reconstruction or compromise the results of repair of the popliteal lesion. Early repair of the muscle anomaly is advocated even in the asymptomatic limb. Two patients with bilateral popliteal artery entrapment causing unilateral popliteal occlusion with distal embolization are reported.

Adolescent↗

The popliteal artery entrapment syndrome: presentation, morphology and surgical treatment of 13 cases.

The morphology, clinical parameters and treatment of the popliteal artery entrapment syndrome (PAES) are presented on the basis of 13 of our own cases and from the literature. PAES is based on a segmental vascular compression due to an anatomical anomaly of the popliteal region and a new classification is presented distinguishing three variants according to the different anatomical conditions. PAES is mostly found in young sportsmen with well-developed muscles. Clinical symptoms are acute or chronic, and the diagnosis is made by physical examination, angiography and Doppler ultrasound, both in neutral position and in plantar flexion. Although thromboendarterectomy in some cases leads to good results, the preferred surgical therapy is decompression of the entrapped artery and reconstruction of the arterial pathway by vein graft interposition. The results were excellent in nine of 13 cases. In two patients, a recurrent thrombosis necessitated a femoro-crural bypass and in two others the entrapment was only diagnosed during reoperation for aneurysms of the venous graft.

Adult↗

Popliteal artery injury associated with knee dislocations.

Since the Vietnam War experience we have known that there is a high association between knee dislocations and popliteal artery injuries. In an effort to improve the quality of care we asked whether every patient with a knee dislocation needs an arteriogram. This is a retrospective chart review of all injured patients who presented to Louisiana State University Health Science Center with knee dislocations between January 1, 1993 and March 31, 1998. Twenty-one patients met the study criteria. There were no deaths in this series. Twelve patients presented with normal palpable pulses. Nine of these 12 patients underwent an arteriogram. There was only one abnormal arteriogram (intimal defect) in this group. None of the patients who presented with normal pulses were operated on. There were no in-hospital complications from this nonoperative management. In the group of patients with either diminished pulses or no pulses arteriograms were performed on all patients. Fifty-five per cent of these arteriograms were abnormal, and one-third of these patients (two) were taken to the operating room for repair. In the group of patients who present with knee dislocations and normal peripheral vascular examination arteriograms are not helpful.

Adolescent↗

Popliteal arterial aneurysm associated with Klippel-Trénaunay syndrome: case report and literature review.

A 35-year-old woman with Klippel-Trénaunay syndrome developed a popliteal artery aneurysm in the affected extremity. The aneurysm was successfully treated by aneurysmectomy and bypass grafting with autologous saphenous vein. In Klippel-Trénaunay syndrome, angiodysplasia in the venous system is common. However, reports of an arterial aneurysm in a patient with Klippel-Trénaunay syndrome are extremely rare.

Adult↗

Assessment of popliteal arterial occlusive disease with 2D time-of-flight MRA.

OBJECTIVE: The purpose of this study was to evaluate both morphology and blood flow in peripheral arteries with occlusive lesions using MR angiography (MRA) and velocity-encoded cine MRI. MATERIALS AND METHODS: Two-dimensional time-of-flight MRA and velocity-encoded cine MRI were performed in nine patients with peripheral arterial occlusive disease. Findings on MR angiograms were verified by conventional angiography. RESULTS: All the stenotic lesions in the popliteal arteries were depicted by MRA. The degree of the stenoses in the artery was overestimated by MRA. Major collateral circulations were demonstrated. Velocity-encoded cine MRI provided flow velocity information on the arteries above and below the stenoses. The flow velocity waveform was monophasic above and below the stenosis. The peak systolic velocity in the artery below the stenosis was reduced compared with that above the stenosis (p < 0.05). CONCLUSION: The combination of MRA and velocity-encoded cine MRI has clinical potential for the evaluation of peripheral arterial occlusive disease.

Adult↗

Arteriosclerosis in popliteal artery trifurcation as a predictor for myocardial infarction after arterial reconstructive operation.

The frequency of myocardial infarction and mortality within 30 days after lower limb vascular reconstruction, in relation to the extent of atherosclerotic lesions in the trifurcation of the popliteal artery, have been retrospectively analyzed in 158 consecutive patients reconstructed in the aortoiliac region and 239 consecutive patients undergoing femorodistal bypass. Among the patients without trifurcational disease (TFD) none had myocardial infarction develop postoperatively, as compared with four of the 50 patients with TFD in the aortoiliac series (p less than 0.05) and 18 of the 174 patients with TFD in the femorodistal series (p less than 0.05). In nine instances, the cause of death was myocardial infarction. The strong correlation between postoperative myocardial infarction and the presence of TFD, may be due to a direct correlation between coronary artery disease and TFD. The finding is of practical importance in the selection of treatment for patients with circulatory disorders of the lower limbs. The finding facilitates the preoperative identification of patients liable to have myocardial infarction develop. Indications for operation can be made more stringent and optimal intraoperative and postoperative monitoring can be instituted.

Acute Kidney Injury↗

Acute popliteal artery occlusion after total knee arthroplasty.

We describe the case of a 71-year-old man with calcium pyrophosphate dihydrate crystal deposition disease who developed acute popliteal artery occlusion immediately after total knee arthroplasty. Reperfusion was achieved thanks to the early diagnosis and thrombolytic therapy with urokinase. Arterial occlusion occurring after total knee arthroplasty is a rare but serious complication. Detailed preoperative evaluation of the peripheral arterial circulation and an early diagnosis seem to be important.

Acute Disease↗