[Reconstruction of the occluded popliteal artery--popliteal artery entrapment syndrome and Buerger's disease (author's transl)].
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Adolescent↗
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Uncommon causes of intermittent claudication: cystic adventitial disease of the popliteal artery and popliteal artery entrapment syndrome.
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Adult↗
Injury to the popliteal artery.
Popliteal artery injury is a common clinical problem which has been associated with a relatively high rate of limb loss. Proper management of popliteal artery injury, which includes attention to minimizing delay, repair of venous injury, careful technique and appropriate fasciotomy can result in substantial improvement in the rate of limb salvage following popliteal artery injury.
Fasciotomy↗
Entrapment of the popliteal artery.
Popliteal artery entrapment is a rare but recognized cause of vascular insufficiency of the lower extremity. The authors describe the condition in a 26-year-old man. Diagnosis depends on arteriographic demonstration of the lesion. Treatment is surgical and should consist of either a bypass procedure or excision with graft interposition. Acute onset of peripheral vascular symptoms in a young person should arouse suspicion of such a lesion.
Adult↗
Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia.
PURPOSE: To assess the efficacy of balloon angioplasty in the superficial femoral artery (SFA) and popliteal artery for relief of lower-limb claudication and critical ischemia. METHODS: All patients who underwent SFA or popliteal balloon angioplasty at the Royal Adelaide Hospital between January 1989 and September 1994 were reviewed. Risk factors, indications, angiographic variables, and complications were assessed. Outcome was expressed in life-table form as patency, limb survival, and patient survival rates. RESULTS: One hundred seventy-six patients (96 men, 80 women) who underwent 200 balloon angioplasty procedures were monitored for a mean of 25 months. Seventy-four percent of procedures were for claudication relief and 26% for critical ischemia. The cumulative patency rate at 24 months for all cases was 46%. The limb salvage rate was 95%, and the patient survival rate was 91% at 24 months. CONCLUSION: Percutaneous transluminal angioplasty of the SFA and popliteal arteries is commonly used to treat claudication and critical ischemia but is associated with a high initial failure rate and poor patency at 24 months. Balloon angioplasty is not recommended to treat claudication.
Adult↗
Natural history of entrapment of the popliteal artery.
Popliteal artery entrapment (PAE) is described with increasing frequency. Reviewing the world literature and corresponding with some investigators, we were able to collect 375 instances in 291 patients, including our personal experience (33 instances in 24 patients). The present study was done to establish the natural history and evolution of PAE. Two groups of patients were created to verify if an early diagnosis and treatment of PAE is justified. Group 1 included 129 patients treated by a simple musculotendinous section. In group 2, 226 patients were treated by a vascular procedure (bypass, thromboendarterectomy, other). Age, symptoms and arteriographic findings were the parameters considered in the two groups. Results demonstrated that patients in group 1 are younger than those in group 2 (p < 0.001). Preoperative symptoms demonstrated a larger number of mild symptoms (paresthesias, a cold foot and cramping after intensive physical training) in group 1, when compared with group 2 (p < 0.001). Arteriography demonstrated a larger number of patients with normal findings at rest, with popliteal stenosis or occlusion during maneuver, in group 1 than in group 2 (p < 0.001). PAE results in progressive arterial impairment. Early noninvasive screening is mandatory to detect PAE at an early stage. Surgical treatment is thereby limited to a musculotendinous section, which has the best results.
Adult↗
The lateral approach to the proximal popliteal artery for popliteal to anterior tibial artery bypass.
The exposure of the proximal popliteal artery through a lateral incision for bypasses to the anterior tibial artery is simple and logical. It avoids the need to direct the graft from the medial to the lateral side of the leg and, therefore, is advantageous when limited autogenous vein is available. The lesser saphenous vein is usually long enough to reach the most distal anterior tibial artery.
Humans↗
[Surgery of superficial femoral artery and popliteal artery].
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Femoral Artery↗
[Injury of the popliteal artery & the popliteal branches: analysis of 31 consecutive cases].
In complex traumas of lower limbs it is fundamental the reducing of the time of ischemia to reduce the number of failures in repairing surgery and the percentage of the demolishing of necessity surgery. The experience of the authors is based on 31 complex traumas of lower limbs with distal vascular injuries to Hunter's canal, which were associated to bone, nervous and muscular lesions. In total we are treated 37 vascular injuries by interposition of venous autografts in 37 cases, lateral pacth in one case ant suture T-T in two cases. The protection of the reconstructed vases, in case of a concomitant loss of substance, was entrused to microvascular flaps for 7 times latissimus dorsi, iliac crest and fascio-cutaneous for 5 times posterior reversed with distal baset and for three times antero-lateral, which in three cases of them needed successively a dermoepidermic grafts. The bone injuries, which were treated by external fixation, intramedullary nailing, plate and screws, just in two cases became worse in pseudoarthroses and just in one in osteomyelitis. The reparation of nervous injuries had bad results just in two cases. The percentage of saving of the limb it was about 83.9%.
Female↗
[Arterial popliteal entrapment syndrome as the cause of acute peripheral ischemia].
The popliteal artery entrapment syndrome results from an abnormal relation of artery and tendomuscular structures in the popliteal fossa, which can compromise the artery. We report our experience in 18 cases of popliteal artery entrapment syndrome in 14 patients (12 men, 2 women) operated on at the University Hospital in Zurich during the period 1967-1988. A follow-up examination was possible in 12 of the 14 patients in whom popliteal artery entrapment syndrome (both legs in 2) was treated surgically. These patients had first presented with ischaemic symptoms at an average age of 30 years. The correct diagnosis of an entrapment syndrome was made at an average age of 36 years. In all, 5 of the 14 patients were affected bilaterally. In 5 cases the first sign was an acute ischaemic syndrome. All these patients were young and had formerly taken active part in sport. The follow-up examination after an average age of 11.25 years showed a very good result in 13 cases, a good result in 2 cases and an unsatisfactory postoperative result in 1.
Adolescent↗
Ultrasound examination in the diagnosis of popliteal artery aneurysms.
Popliteal artery aneurysm is a potentially limb-threating lesion which is frequently difficult to diagnose by clinical examination or angiography. The risk of limb loss can best be reduced by early diagnosis. Over the past 5 years we have prospectively evaluated ultrasound examination of the popliteal space in screening patients with clinically suspected popliteal artery aneurysms. One hundred patients who were suspected clinically of having a popliteal artery aneurysm underwent bilateral ultrasound examination of their popliteal fossae. There were 21 patients who had abnormal scans. The problems identified were popliteal artery aneurysm in thirteen patients, popliteal artery ectasia in four patients, Baker's cyst in two patients, thrombosis in one patient and popliteal stenosis in one patient. Eight patients with eleven popliteal artery aneurysms by ultrasound also underwent angiography. Seven of the aneurysms were confirmed, four were missed. All eleven aneurysms were confirmed at operation. In addition, angiography did not demonstrate an aneurysm in any patient with a normal ultrasound. This study confirms that ultrasound examination is a quick, accurate, and non-invasive method of screening for popliteal artery aneurysms.
Adult↗
[Bilateral aneurysms of the popliteal artery].
INTRODUCTION: Popliteal artery aneurysms are the most common of peripheral arterial aneurysms. Popliteal aneurysms are bilateral in 42% of patients. Atherosclerosis and bacterial invasion of the arterial wall are the predominant etiologic factors of popliteal artery aneurysms. CLINICAL CASE: A male of 67 years old was referred to our institution for bilateral claudication and 150 m. free interval. The angiogram showed a partial occluded aneurysm of the right popliteal artery and a complete thrombosis of the left popliteal artery aneurysms. The left aneurysm was resected and a femoral popliteal by-pass was performed, using the inverted saphenous vein graft, associated with left lumbar sympathectomy. Six months later the contralateral aneurysm was excised and a Dacron femoro-popliteal by-pass graft was performed. Two years later Arteriographic and Doppler examination showed patent by-pass bilaterally. CONCLUSION: Popliteal artery aneurysms can be a threaten for the lower limbs, because of thromboembolic phenomena and occasional rupture. Surgery is the best treatment before the appearance of an acute complication and a by-pass with an autogenous vein graft or a Dacron graft are the most common surgical procedures performed. Thrombolytic therapy offers good results where an acute complication appears.
Aged↗
Cystic adventitial disease of the popliteal artery: elongation into the media of the popliteal artery and communication with the knee joint capsule: report of a case.
Cystic disease of the popliteal artery is a rare disorder in which most cases involve the formation of an adventitial cyst that disturbs the popliteal artery blood flow. We present herein the case of a patient presenting with popliteal artery occlusion due to compression by a cyst which formed at the media of the popliteal artery. The onset occurred during a baseball game in which he played catcher. Preoperative magnetic resonance imaging demonstrated a communication of the cyst with the adjacent knee joint. This unusual case could provide important clues to help identify the pathogenesis of this disease.
Adult↗
In-situ saphenous vein bypass graft for popliteal artery aneurysm.
Popliteal artery aneurysms are dangerous and limb threatening; they can present with various ischemic symptoms. Surgical treatment is advised to avoid thromboembolic complications. In most cases the aneurysm is bypassed with a tunnelled reversed saphenous vein or with a prosthetic graft followed by ligation of the popliteal artery. In the popliteal fossa, the close relation between the graft and the aneurysm may cause graft failure. Four patients with symptomatic popliteal artery aneurysms were treated with an extra-popliteal in-situ saphenous vein graft, so far without failures. An additional advantage of an in-situ graft is the better result in case of a distal anastomosis.
Aged↗
[Superficial femoral artery autotransplantation for popliteal artery damage: a good solution?].
We chose not to use a vein to bypass a popliteal artery lesion in four preferring to perform an autotransplantation of a proximal segment of the homolateral superficial femoral artery. The proximal arterial segment translated downstream being replaced by a synthetic graft. This approach was used to treat a popliteal aneurysm in two patients and cystic adventitiel disease in two others. The great saphenous was unfit for bypass in two patients. One patient died with a patent transplant nine Months after surgery due to an unrelated urological problem. The other three patients were alive and symptom free, at least forty-two Months after surgery. All three had a patent transplant despite obstruction of the proximal synthetic bypass in one patient. Provided that the outcome in a larger number of cases confirms these favourable results, we think that this technique offers an attractive alternative to venous bypass, at least whenever a venous graft cannot be used.
Aged↗
Popliteal arterial traumas: prognosis factors: multi-center prospective study apropos of 40 cases.
Forty cases of arterial popliteal traumas occurring in the course of 1992 were collected by 20 centers. The purpose of this prospective study was to evaluate a preoperative prognosis score suggested by Crolais from a retrospective study. Five clinical criteria are taken in account to establish the score: delay, degree of ischemia, contusion, general condition of the patient and wound apperture. Each of the criteria is affected by a progressive note according to the gravity. Analysis of our series confirms the seriousness of this pathology: one death, 8 major amputations and 50% of morbidity. The statistical analysis of pre-operative score and post-operative recovery confirms the existence of three groups at progressive risk: Low risk, score < 30 points. Revascularization must be done. Post-operative recovery is simple. Average risk, score is between 31 and 50 points. Revascularization must be done. Post-operative recovery is particularly simple as the delay before revascularisation will be short and systematic fasciotomies will be done. Major risk, score > 50 points. An amputation must be carried out.
Adult↗
Ruptured popliteal artery aneurysm.
Popliteal artery aneurysms rarely rupture. We treated a 91-year-old man who presented with a deep venous thrombosis and anemia; rupture of a popliteal artery aneurysm was suspected only after compartment syndrome isolated to the thigh developed as the result of bleeding. Although fasciotomy was required on the basis of the clinical examination alone, the cause of the problem, operative strategy, and definitive treatment (i.e., resection and bypass) were clarified by the preoperative computed tomography scan. Ruptured popliteal aneurysm can manifest as a massively swollen leg with anemia and should be suspected if no other cause is evident.
Aged↗
Experimental remarks on leg ischemia following popliteal artery injuries.
Popliteal artery injuries are followed, in many cases, by amputation of the leg. Results after re-construction depend on the time of ischemia. In this experimental work 12 dogs with injury of the popliteal artery had a direct end to end anastomosis or an anastomosis using saphenous vein graft. Blood flow was checked by an electromagnetic flowmeter or ultrasounds, blood samples for Hb, oxyhaemoglobin saturation, Hct and ph were taken before and after operation. Changes in these values depend on the time elapsing between injury and re-establishment of circulation. Operative angiography was done in all dogs. Except in two dogs, no early or late thrombosis occurred. Three dogs required amputation. The outcome of the operation is related to the time elapsing between injury and restoration of circulation.
Animals↗