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At least 631 records · Page 35Linked to original sources
PubMed2000

Rapid intermittent compression increases skin circulation in chronically ischemic legs with infra-popliteal arterial obstruction.

BACKGROUND: Intermittent pneumatic compression (IPC) has been shown, by duplex, to increase popliteal artery flow in normal legs and in legs with superficial femoral artery occlusion. The objective of this study was to see if IPC improves distal circulation in legs with severe infra-popliteal disease. PATIENTS AND METHODS: Sixteen chronically ischemic legs with arteriographically demonstrated crural or pedal disease were studied during compression with an ArtAssist compression-device. This device delivers rapid compression of the foot and calf. Cutaneous laser-Doppler flux was measured continuously at the dorsal aspect of the distal forefoot. The findings were compared to those in thirteen normal controls of similar age. RESULTS: In ischemic legs, the spontaneous changes in skin-flux are minimal: mean resting flux in sitting position was 0.87 +/- 0.46 AU (Arbitrary Units). Upon activation of the compression device the maximum flux increased to 4.55 +/- 1.35 AU. The difference was statistically significant (p < 0.001). This response was similar to that in normal controls. CONCLUSION: Arterial flow augmentation upon compression is associated with increased skin-flux. This response remains present in severe disease of the crural outflow-arteries. Further investigation to define the role of intermittent compression for management of chronic arterial disease is warranted.

Aged↗
PubMed2004

Popliteal artery aneurysms. Factors associated with thromboembolism and graft failure.

AIM: The purpose of this study was to review our experience with popliteal artery aneurysms (PAAS) and to identify the major factors associated with thromboembolism of PAAS and failure of grafts after surgical repair. METHODS: The medical records of 38 patients with 42 PAA, who presented in a university medical center between March 1985 and September 2000, were retrospectively reviewed. Data were collected on clinical presentation, risk factors, type of reconstructions, early and late morbidity, limb loss and mortality. Duplex scan, as well as computed tomography, was performed in 33 (78.6%) cases, and preoperative angiography in 38 (90.5%). Thrombolysis was performed prior to surgical reconstruction (16.07+/-21.97 months) in 4 cases presented with acute ischemia. All patients underwent synthetic (23, 54.8%) or autogenous (19, 45.2%), below-the-knee (39, 92.9%) or above-the-knee (3, 7.1%) femoropopliteal bypass graft. The proximal and distal anastomoses were end-to-end both in both cases in 30 bypasses (71.4%). Thirty-six (86%) aneurysms were surgically treated by one vascular surgeon. Postoperative anticoagulants were given in 8 cases (19%). Long-term follow-up (mean: 57.59+/-37.77 months) was available for 35 patients (92.1%). Multivariate analysis was used to assess association between risk factors and outcome. RESULTS: Thirty-five patients were males, 3 were females; mean age was 68.31+/-8.66 years. Risk factors were arterial hypertension (25, 69%), smoking (19, 50%), dyslipidemia (7, 18.4%) and diabetes (5, 13.2%). Thirty PAAS (71.4%) were symptomatic for acute (11, 26.2%) or chronic (7, 16.7%) ischemia, distal embolization (8, 19%), compression of the popliteal fossa (3, 7.1%) and rupture (2, 4.8%, one of which presented with acute ischemia); 12 were asymptomatic. Bilateral PAAS were present in 18 patients (47.4%); 14 (36.8%) also had an abdominal aortic aneurysm (AAA); associated AAAS were twice as common in patients with bilateral PAAS (9/18, 50%) compared to those with unilateral PAAS (5/20, 25%; p=NS). The mean diameter of the PAAS was 3.4 cm; no significant difference was found in the mean diameter of symptomatic and asymptomatic aneurysms. Complete thrombosis of the aneurysmal sac was found in 15 cases (35.7%), severe atherosclerotic femoro-popliteal lesions in 17 (40.5%), arteriomegaly in 11 (26.2%), occlusion of the superficial femoral artery (SFA) in 7 (16.7%). Three leg arteries were present in 17 limbs (40.5%), 2 in 6 (14.3%), 1 in 7 (16.7%), no leg vessels in 12 (28.6%). Occlusion of the SFA and the absence of major leg arteries were independently associated with thrombosis of the aneurysmal sac (p=0.005). Two-thirds of patients with thrombosed PAA (10, 66.7%) presented with acute ischemia, while 1/3 (5, 33.3%; p=NS) had some degree of claudication. Optimal runoff (score=1) was estimated in 23 limbs, while score was between 2-7 in 19 limbs. Thrombolysis was successful in all 4 cases, with no complications. Primary graft patency was 66.1% at 4 years; the only variables independently associated with loss of bypass patency were smoking (p=0.04) and poor leg runoff (p=0.02). Postoperative bypass occlusion occurred in 2 cases presented respectively with acute and chronic ischemia, and in 2 asymptomatic patients; all 4 bypasses were polytetrafluoroethylene grafts. A total of 8 thrombosed, polytetrafluoroethylene, below-the-knee bypass grafts required secondary reconstructions (2 redo + 6 restorative procedures). The secondary patency rate at 3 years was 77.9%. Lower limb amputation had to be performed 2 months after primary reconstruction in 1 case (2.4%) presented with acute ischemia. The estimated limb salvage rate at 10 years was 96%. Mortality was 4.8%. Survival at 6 years was 82.6%. CONCLUSION: Our experience indicates that SFA occlusion and poor runoff vessels were independent factors associated with PAA thrombosis. The diameter of asymptomatic PAAs was not significantly different than that of asymptomatic ones. Use of tobacco and poor runoff vessels were independent factors associated with primary bypass patency. In PAAs complicated with acute ischemia, thrombolysis allowed us to regain a good runoff and to perform subsequent bypass procedure, with no amputation. The use of autogenous graft material, when possible, is recommended.

Aged↗
PubMed1992

Femoral and popliteal arteries: reanalysis of results of balloon angioplasty.

The author presents an alternative statistical analysis of the results of the University of Toronto series of percutaneous transluminal angioplasty (PTA) of the femoral and popliteal arteries (n = 254). After recalculation of the data with the Kaplan-Meier method, the postprocedure success rate ranged from 88.8% +/- 2.0 at 1 month to 35.7% +/- 4.8 at 6 years. With Cox multiple regression analysis, the type of femoropopliteal lesion and the runoff were the variables that were useful to predict late results. For stenoses with good runoff, the success rate was 53% at 5 years; with poor runoff, 31% at 5 years. For occlusions with good runoff, the success rate was 36% at 5 years; with poor runoff, 16% at 5 years. In initially successful cases, ongoing clinical success at 1, 3, and 5 years was better in patients with good runoff at the time of PTA than in those with poor runoff. Now that more recent studies have documented improved technical success in femoropopliteal PTA, a comparative study of the relative safety, long-term clinical efficacy, and cumulative cost of PTA versus surgery seems warranted.

Angioplasty, Balloon↗
PubMed2003

Efficacious use of nitinol stents in the femoral and popliteal arteries.

OBJECTIVE: To evaluate the performance and identify predictors of outcome after the use of self-expanding nitinol stents in the treatment of femoropopliteal arterial occlusive disease. METHODS: A retrospective analysis of a prospectively collected database was performed. Outcomes of patients who underwent placement of a nitinol stent in the femoral or above-knee popliteal arteries between 1999 and 2002 were studied. Patency, limb salvage, and patient survival were determined by Kaplan-Meier estimation and intergroup comparisons by log-rank test and Cox proportional hazards model. To define individual factors associated with clinical outcomes, stepwise regression analysis was performed. RESULTS: A total of 41 patients (mean age, 70 +/- 10 years; gender, 26 men and 15 women) underwent percutaneous placement of nitinol stents. Limb salvage was the indication for intervention in 68% of patients. Diabetes was present in 54%, and 36% had end-stage renal disease. Nitinol stents were placed in the superficial femoral (35 patients) or the above-knee popliteal (6 patients) arteries. The mean postprocedural increase in ankle-brachial index was 0.32 +/- 0.19. The 6-month, 1-year, and 2-year primary patency and limb-salvage rates were 95%, 84%, and 84%, and 92%, 89%, and 89%, respectively. Major amputations occurred only in patients undergoing limb-salvage procedures presenting with major tissue loss. No statistically significant differences in patency were seen with regard to diabetes, end-stage renal disease, runoff score, length of vessel stented (median, 80 mm), hypertension, or smoking. CONCLUSIONS: Our initial experience with self-expanding nitinol stents for femoropopliteal occlusive disease appears to demonstrate acceptable patency and limb-salvage rates at these early time points. Further evaluation of clinical outcome with these devices in this and larger groups of patients is warranted.

Aged↗
PubMed1983

Latissimus dorsi myocutaneous free flap vascularised by an extra-anatomic graft in the lower limb following traumatic disruption of the popliteal artery.

A case is presented in which the thoracodorsal artery of a latissimus dorsi free flap was anastomosed to an autogenous reverse saphenous bypass graft. The bypass graft was used to revascularise a leg with traumatic disruption of the popliteal artery and an open comminuted fracture of the distal tibia and fibula with extensive soft tissue loss. At 2-year follow up, isotope scans showed patency of the extra-anatomic graft and a good flow into the thoracodorsal artery.

Adult↗
PubMed2006

[Acute extremity ischemia based on the popliteal artery aneurysm thrombosis--combined thrombolytic and surgical management].

Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.

Acute Disease↗
PubMed1985

[Localization of different types of collagen (I, III, IV, V) in the connective tissue of the popliteal artery and skeletal muscle of man (immunoelectronmicroscopic analysis)].

By means of immunoperoxidase and immunoferritin techniques collagen of the I, III, IV and V types has been revealed in cryostat sections of the popliteal artery and in the musculus quadriceps of the femur. Areas of the vascular wall without any macroscopical signs of lesions have been investigated. They have been obtained from amputated extremities of young persons (17-22 years old), and muscle pieces have been taken during operations performed in the knee joint. After certain immunocytochemical procedures the cryostat slices are embedded in mixture of epon 812 and araldit, non-contrasted ultrathin slices are examined in the electron microscope JEM 100CX. Collagen of the I and III types is revealed in fibrills 20-80 nm thick either with or without cross striation, as well as in microfibrills. Collagen of the III type in the intercellular substance of the arterial wall occurs in nonfibrillar form. Collagen of the IV type is revealed in basal membranes of the smooth muscle cells of the arterial wall, of the muscle fibers and of endothelium of blood capillaries of the skeletal muscle. Collagen of the V type is found as accumulations having various size and form; they localize in many places of the intercellular substance of the arterial wall. A tight contact is revealed between the formations including collagen of the V type with drops of elastin and elastic fibers. A suggestion is made that collagen of the V type participates in formation of elastic fibers.

Adolescent↗
PubMedDate not supplied

[Fibrocystic deterioration of the popliteal artery. Apropos of 1 case].

Set off by a sports movement, a subacute ischemia of the lower limb allowed the delayed discovery of a segmental stenosis of the popliteal artery in a young man. It involved a compression by fibro-cystic deterioration of the wall of the artery. Separation of the cyst from the diseased arterial wall was followed by the restoration of circulation by means of an internal saphenous vein graft.

Adult↗
PubMed1980

Traumatic aneurysm of the popliteal artery due to an osteochondroma of the femur.

The authors report the case of a 51-year-old man who had a false aneurysm of the popliteal artery caused by erosion by an adjacent osteochrondroma of the femur. The osteochondroma was removed and the artery repaired by end-to-end anastomosis. Seventeen similar cases, which have been recorded in the past 15 years, are reviewed. These reports emphasize the importance of surgical repair to avoid permanent ischemic damage to the leg and foot.

Aneurysm↗
PubMed1992

[Cystic disease of right popliteal artery with spontaneous resolution].

The case was 50-year-old man. He was admitted to our hospital suffering from intermittent claudication. DSA and CT showed stenosis of the right popliteal artery due to compression by the tumor like lesion. The adventitial cystic disease was suggested. Three weeks later he had no symptom. DSA and CT revealed no reappearance of the adventitial cystic disease. The popliteal adventitial cyst spontaneously decreased in size. It is a very rare case.

Angiography, Digital Subtraction↗
PubMed1995

Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?

PURPOSE: The purpose of this study was to determine the effectiveness of percutaneous transluminal angioplasty (PTA) for treatment of patients with localized stenosis of the infrageniculate popliteal artery and tibio-peroneal trunk (IGPA). METHODS: The records of 25 patients undergoing IGPA PTA from 1983 to 1993 were reviewed. Patients underwent follow-up with clinical examinations, ankle-brachial indexes, Duplex scanning, and arteriography. Demographic variables and cardiovascular risk factors were analyzed and correlated with outcome. RESULTS: Mean follow-up was 44 months. With life-table analysis, clinical and hemodynamic success was 59%, 32%, and 20% at 1, 2, and 3 years, respectively. Average time to recurrence was 17 months. Sixteen patients required a subsequent procedure; two had only repeat PTA, six had repeat PTA followed by arterial bypass, and eight had bypass alone. The mean additional benefit of repeat PTA was 8 months. Eleven of the 14 patients treated with bypass became symptom-free with patent grafts at a mean follow-up of 52 months. No risk factor was statistically significant in predicting success of IGPA PTA. CONCLUSIONS: IGPA PTA is an expensive temporizing measure with a high rate of recurrence requiring subsequent intervention. The procedure should be restricted to patients with limited life expectancy or contraindications to operation.

Aged↗
PubMed2003

The effect of knee flexion on the popliteal artery and its surgical significance.

Total knee replacement and high tibial osteotomy are common orthopaedic operations with low complication rates. Such surgery is in close proximity to the popliteal artery (PA), the behaviour of which during flexion of the knee is poorly understood. We used Duplex ultrasonography to determine the distance of the PA from the posterior tibial surface at 0 degrees and 90 degrees of flexion in 100 knees. When the knee was flexed the PA was closer to the posterior tibial surface at 1 to 1.5 cm below the joint line in 24% and at 1.5 to 2 cm below the joint line in 15%. There was a high branching anterior tibal artery in 6% of knees. We provide an anatomical account to help to explain our findings by using cadaver dissections, arteriography and static MRI studies.

Adult↗
PubMed2003

Isolated complete popliteal artery rupture associated with knee dislocation. Case reports.

Complete dislocation of the knee is a rare injury, and is frequently associated with injuries to other structures in the popliteal fossa. Prompt recognition of associated popliteal artery disruption and early revascularization is paramount for successful and functional results. The necessity for emergency vascular reconstruction markedly complicates an already difficult orthopaedic problem. Arteriography is recommended in all cases of complete dislocation of the knee.

Adolescent↗
PubMed2001

[Recurrence of cystic adventitial degeneration of the popliteal artery--magnetic resonance tomography and MR angiography].

Adventitial cystic disease is a rare disorder characterized by mucin-containing cysts of the adventitial tissue. The condition has a predilection for the popliteal artery. Men are predominantly affected, usually around the fourth decade. We report of a case of recurrent adventitial cystic disease and the possibilities of modern cross-sectional imaging. In particular we discuss the advantages of magnetic resonance imaging and magnetic resonance angiography for the diagnosis of this condition. Furthermore, the etiology and the possibilities of surgical treatment are illustrated.

Arterial Occlusive Diseases↗
PubMed1996

[Aneurysms of the popliteal artery. Our experience apropos of 37 cases].

The authors describe their experience concerning the surgical treatment of aneurysmatic pathology of the popliteal artery. This is the most frequent site for aneurysm after aortic aneurysm. Since 1979 to 1994, 26 patients, 21 men and 5 women (mean age 65.8 years), have been treated at the Institute of Clinical Surgery of the University of Ferrara for a total of 37 popliteal aneurysms. Thirteen patients had more than one aneurysm. Before the operation, all patients underwent DSA, and echo Doppler, 7 with CAT and 4 with RMN. Twenty-nine substitutions, 7 by passes and 1 ligation were performed. Twelve of the 29 substitutions were made by reversed saphenous vein. Fourteen by PTFEe, and 3 by dacron. In 4 cases it was necessary to reimplant either the anterior tibial artery (3 cases) or the posterior tibial artery (1 case) separately. The results obtained were good especially in the post-trauma patients. Only 3 amputations were necessary due to graft obstruction immediately after surgery, and in post-traumatic conditions.

Aged↗
PubMed1996

[Aneurysm of the popliteal artery. A case contribution of a 15-year surgical experience].

This retrospective study involves 45 patients operated in the years 1980-1994 for popliteal artery aneurysms with a posterior approach. The number of aneurysms is 60 because 15 were bilateral; 18 patients presented a polianeurysmatic involvement of the arterial tree. In 14 cases the intervention were performed on asymptomatic patients, in 46 cases the patients were symptomatic for ischemic disease. The reconstructive interventions were performed on 58 cases and only in 2 cases the medial approach to popliteal vessel were preferred on the basis of the great dimension of the aneurysms which involved also the superficial femoral artery. PTFE grafts were adopted in 33 cases, saphenous vein in 19 cases and Dacron grafts in 5 cases. We had no perioperative mortality and 4 patients died for causes not correlated to the intervention. We had perioperative complication in the group of asymptomatic patients. In the group of symptomatic patients 5 underwent a major amputation. The global patency of these grafts is 86% after 10 years. The posterior approach to the popliteal vessels has the advantage of a better view of the aneurysmatic mass and the anatomic structures and it permits a direct end graft. This graft is usually shorter than in the case of the medial approach and cannot be compressed by the aneurysmatic mass.

Aged↗
PubMed1983

Intramuscular pressure after revascularization of the popliteal artery in severe ischaemia.

Swelling is known to occur after peripheral revascularization. In this study of 14 patients undergoing revascularization of the popliteal artery for severe ischaemia, leg swelling and intramuscular pressure were recorded before and after operation. Calf circumference increased with a maximum swelling of 3.9 +/- 1.1 cm on postoperative day 6. There was a gradual increase in intramuscular pressure from 9 +/- 2 mmHg on the day before operation in the anterior tibial compartment to a maximum pressure on postoperative days 6-7 of 26 +/- 4 mmHg. Similar intramuscular pressure changes were seen in the superficial posterior compartment. These high intramuscular pressures may lead to a compartment syndrome and perhaps graft failure, which was actually observed in one case. Deep-vein thrombosis in the postoperative course may contribute to the high intramuscular pressures. Phlebography revealed a deep-vein thrombosis in 2 patients. In conclusion popliteal revascularization causes leg swelling and increased intramuscular pressure which may lead to a compartment syndrome and graft failure. Therefore follow-up of intramuscular pressure in patients with marked swelling after distal revascularization procedures and early fasciotomy may be considered on wide indications.

Aged↗