Popliteal Artery Pseudoaneurysm After Arthroscopic Cystectomy of a Popliteal Cyst

A case of popliteal artery aneurysm after arthroscopic cystectomy of a popliteal cyst is an uncommon complication, and no case has been reported. We present a case of pseudoaneurysm of the popliteal artery after arthroscopic cystectomy of a popliteal cyst 2 months after surgery. Open excision of the pseudoaneurysm and popliteal artery pin-point repair were done. At 30 months' follow-up, both the tibialis posterior and dorsalis pedis pulsations were felt equally on both sides with normal sensations over the limb. Retrospectively reviewing the case, we found that the relation of the popliteal artery and popliteal cyst on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery. It is better not to shave the lateral aspect of the cyst while performing arthroscopic cystectomy when magnetic resonance images show that the popliteal artery is close to the cyst.     

Calf Pain and Cystic Adventitial Disease of the Popliteal Artery

In a 61year-old women, suffering a left calf pain for more18 months, a diagnosis of cystic adventitial disease of the popliteal artery was confirmed by scanner. At the operation, we found an intramural cyst of the popliteal artery. A total resection of the cyst and of the artery (resection & end to end anastomosis) was performed. Adventitial cystic disease represents 0, 1% of the vascular diseases (3). The popliteal artery seems to be the most frequent site.     

Popliteal Artery Thrombosis Secondary to Exostosis of the Tibia

This report describes an exceptional case of popliteal artery thrombosis secondary to exostosis of the superior extremity of the superior tibia in a young adult. Correct diagnosis was made during re-operation for recurrent thrombosis. Surgical treatment consisted of resection of the bony tumor and venous bypass to reestablish arterial continuity. Femoropopliteal vascular complications of exostosis are rare, with most cases involving arterial aneurysms or false aneurysms. Differential diagnosis in our young patient took into account the other causes of popliteal thrombosis: entrapped popliteal artery, adventitious cyst, fibrodysplasia, and juvenile arteriopathy. In patients with major functional disability, operative treatment is recommended to remove the bony abnormality and repair the arterial lesion.     

Embolism of the Popliteal Artery by A Ruptured Hydatid Cyst of the Heart

A case of embolism of the popliteal artery by the membrane of a ruptured hydatid cyst of the heart is presented.     

Popliteal Artery Pseudoaneurysm Caused by Osteochondroma

A 49-year-old man with asymptomatic osteochondroma was found to have a pseudoaneurysm of the left popliteal artery. An angiography showed a popliteal artery pseudoaneurysm adjacent to a femoral osteochondroma. The osteochondroma was excised and the popliteal artery containing the tear was also excised by end-to-end anastomosis. Vascular complication of osteochondroma is extremely rare. Paul reported the first case of a popliteal artery pseudoaneurysm due to an osteochondroma in 1953. A computerized literature search revealed 40 additional cases reported in English, providing sufficient detail to allow comparison. The average age of the patients was 22.6 years (range: 9-51 years) and most cases identified involved males (30 of 41, 73%). Most pseudoaneurysms were located in the popliteal artery. This report discusses the authors experience with this disorder and a review of the literature in English.     

Recanalization of an Occluded Popliteal Artery following Posterior Knee Dislocation

Posterior knee dislocation results in popliteal artery injury in up to one-third of cases. Prompt recognition and treatment of arterial injury is essential for limb salvage. We report a case of complete occlusion of the popliteal artery following posterior knee dislocation treated with saphenous vein bypass without exclusion of the injured arterial segment. Follow-up duplex scanning demonstrated a patent vein graft and a patent ipsilateral popliteal artery. This report suggests that, in some instances, a traumatically occluded popliteal artery may recanalize, and that revascularization with a bypass graft may be the preferred method of repair, particularly in young patients.     

Endoluminal Angioplasty of the Popliteal Artery. Review of 54 Consecutive Patients

AIM: To determine the results of endoluminal angioplasty for occlusive or stenotic lesions of the popliteal artery. METHODS: Retrospective study of symptomatic patients having popliteal occlusive lesions treated by endoluminal balloon angioplasty. All patients underwent systematic preoperative and postoperative color duplex scan and preoperative angiography. The principal endpoints were primary and primary assisted patency. RESULTS: Fifty-four percutaneous endoluminal angioplasties of the popliteal artery, including six procedures with stents, were performed in 50 patients. In all cases, the superficial femoral artery was patent and without significant stenosis. Primary patency for the entire cohort was 57.4+/-6.7% at 1 and 2 years. Primary assisted patency was 86.3+/-4.8% at 1 year, and 79.1+/-5.9% at 2 years. The results of angioplasty appeared to be better in patients with intermittent claudication when compared to patients with critical limb ischaemia, (p=0.0006). Angioplasty of single occlusive lesions had a better prognosis than that of multiple occlusive lesions (p=0.01). Results of angioplasty were better at the below-knee and median popliteal artery than at the femoro-popliteal junction or in the above-knee popliteal artery (p=0.03). Tibial run-off and isolated popliteal stenosis versus isolated popliteal thrombosis did not seem to affect primary patency rate. CONCLUSION: Results of angioplasty of the popliteal artery are acceptable for claudicants, especially those with TASC-A lesions and those with lesions in the distal two thirds of the popliteal artery.     

Popliteal artery stenosis caused by a Baker's cyst

Popliteal artery compression may be caused by a Baker's cyst as documented by this case report. Typically this occurs in a relatively young patient without other evidence of atherosclerosis. The ischemic symptoms may be intermittent. Treatment should include resection of the offending cyst and any damaged popliteal artery.     

Popliteal artery agenesis: a new anatomic variant

Agenesis of the popliteal artery has not been described as a vascular anomaly in the lower extremity. This case report describes congenital absence of the popliteal artery discovered during operative exploration after a traumatic injury to the lower extremity. The preoperative arteriogram suggested acute occlusion of the popliteal artery. Intraoperative exploration and arteriography were consistent with agenesis of the popliteal arterial segment, and postmortem examination confirmed these arteriographic and intraoperative observations. Embryologically, failure of the middle portion of the sciatic artery to persist would account for this anomaly. A review of series reporting congenital anomalies of the lower extremity vasculature failed to discover previous mention of this particular abnormality. Agenesis of the popliteal artery should be included among those vascular anomalies that may affect management of lower extremity vascular disease.     

Aneurysm of the Popliteal Artery in Neurofibromatosis

The neurofibromatoses are a heterogeneous set of genetic disorders having clinical manifestations that involve the skin, the nervous system, or both. In addition, the disease can be confounded by a broad spectrum of complications, such as various kinds of osseous lesion, vascular lesions, aqueduct stenosis, optic glioma, and learning disabilities. Neurofibromatosis results in vascular involvement in approximately 10% of cases. Stenotic lesions predominate, but aneurysms have been documented as well. Rarely noted, however, have been peripheral aneurysms. In this report, we discuss the case of a 66-year-old woman with type 1 neurofibromatosis and a popliteal artery aneurysm who was operated upon because of threatened limb ischemia. Histological findings confirmed neurofibromatous invasion of the vessel wall.     

Adventitial Cystic Disease of the Popliteal Vein: Report of a Case

Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease seen mainly in arteries. It is very unusual for these cystic masses to develop in a vein. We report the case of a 56-year-old woman with leg swelling caused by ACD arising in the popliteal vein. The swelling appeared after a long period of standing. Magnetic resonance imaging (MRI) showed a popliteal cystic mass and venography showed disrupted venous flow. We resected the cyst wall without venous reconstruction, after which venous blood flow normalized and her symptoms subsided. To our knowledge, this is only the third documented case of ACD arising in the popliteal vein. A misdiagnosis could easily have been made, since the mass was not obvious on physical examination and the only symptom was intermittent swelling. Thus, it is important to be aware of ACD as a possible diagnosis when examining patients with a swelling in the leg.     

Cystic Adventitial Disease of the Popliteal Artery: Report of a Case

The etiology of cystic adventitial disease is unknown and the optimal treatment modality remains to be elucidated. We report a 58-year-old man diagnosed to have cystic adventitial disease in the popliteal artery, who was treated by a resection of the diseased segment of the arteries and then underwent reconstruction with a reversed saphenous vein graft interposition.     

Popliteal Artery Pseudo-Aneurysm and Hereditary Multiple Exostoses

We describe a rare case of a 21-year-old man presenting with hereditary multiple exostosis and a pseudo-aneurysm of the popliteal artery caused by femoral osteochondroma. Principles of management and surgical technique are discussed.     

Ruptured Pseudo-aneurysm of the Popliteal Artery after Percutaneous Transluminal Angioplasty

An 88-year-old female presented with gangrene of two toes of the left foot. Angiography revealed a calcified occlusion of the left popliteal artery, 8 cm in length. Recanalisation was performed and the occlusion was successfully dilated. On day 13 after the procedure, the patient experienced acute pain in the left popliteal fossa. Ultrasound revealed a large pseudo-aneurysm of the popliteal artery. Angiography not only confirmed this finding but showed rupture of this pseudo-aneurysm. An above-knee amputation was performed.

Pseudo-aneurysm formation at the site of previous PTA is considered as a rare complication and has not been reported in the literature. The incidence of pseudo-aneurysm formation at a PTA site is unknown because it is not routinely detected. Predisposing general and local factors are discussed. The present case illustrates that pseudo-aneurysms can cause other major complications with disastrous consequences for the patient.

Pseudo-aneurysms after previous PTA should be treated by conventional bypass surgery or by endovascular means. Further studies should be undertaken to evaluate the risk of pseudo-aneurysm formation after previous PTA and to define which patients should be monitored closely.     

功能性腘动脉陷迫综合征的CTA解剖特点初探

目的运用CTA标线法探讨功能性腘动脉陷迫综合征(functional popliteal artery entrapment syndromef,PAES)是否存在"解剖畸形"。方法 2007～2011年手术确诊的14条fPAES患肢与180条对照肢体的CTA进行比较,并用CTA标线法分析腘窝轴位上两组的解剖位置差异。结果 fPAES组所有患肢腓肠肌内侧头向外移位且13条(93%)向外超过了腘动脉,所有腘动脉均向深方移位;对照组腓肠肌内侧头完全起自"股骨内侧髁后上方"(解剖学所描述的标准位置)的仅占12%(21/180);对照组21%(38/180)腓肠肌内侧头与腘动脉相对位置关系及38%(68/180)的腘动脉深浅位置关系不符合标准解剖。结论腓肠肌内侧头的外移普遍存在,解剖"移位"可能从量变到质变f,PAES可能是严重移位导致的结果。内侧头外移超越腘动脉及腘动脉向深方移位是fPAES两个有意义的观察指标。     

Surgical Management of Septic Arthritis of the Knee With a Coexistent Popliteal Cyst

We report a case of knee pyarthrosis in a 54-year-old woman with rheumatoid arthritis and a popliteal cyst. The onset of infection coincided with a cortisone injection. Initial management consisted of arthroscopic irrigation and debridement (I&D) on 2 consecutive occasions without resolution of the infection. Only after open excision of the popliteal cyst in conjunction with I&D of the knee joint proper did the infection resolve. This is the first reported case of a patient requiring excision of a popliteal cyst to clear pyarthrosis of the knee after failure of arthroscopic I&D. Consideration should be given to open debridement or drainage of popliteal cysts in patients who present with septic arthritis in the presence of a popliteal cyst. A treatment algorithm for managing this clinical scenario is presented.     

腘动脉下段分叉部损伤的早期修复

文章报告了9例腘动脉下段分叉部损伤的治疗结果。除1例为土枪霰弹伤外,其余均为钝性暴力所致。早期截肢2例,后期截肢1例,截肢率33.3％。存活肢体中1例明显小腿缺血性挛缩,1例轻度小腿缺血性挛缩,4例功能基本正常。腘动脉下段分叉部损伤具有血管损伤范围广,远端缺血严重,常伴有骨、关节及皮肤、肌肉、神经等组织损伤等特点。尽早手术,同时重建胫前、胫后动脉血循环,尽量修复及保护伤肢静脉,常规行小腿深筋膜切开减压,骨折、脱位同时予以修复并可靠固定是提高治疗效果的必要措施。     

腘动脉压迫综合征八例

目的 总结腘动脉压迫综合征诊治经验.方法 回顾性分析2002年7月至2010年7月收治的8例患者临床资料,其中男性7例,女性1例,年龄16～56岁,平均(29±14)岁.6例经腘窝S形切口发现并解除解剖畸形,2例腘动脉局限性狭窄合并远侧腘动脉瘤,其中1例行腘动脉缩缝成形,1例切除部分动脉瘤壁以自体大隐静脉补片成形;4例患者腘动脉闭塞,其中2例行腘动脉血栓内膜剥脱术(1例自体大隐静脉补片成形术),1例行自体大隐静脉间置术,1例行自体大隐静脉旁路手术.2例腘动脉闭塞病变较长者直接经膝下内侧切口行自体大隐静脉旁路手术.结果 8例患者术后恢复良好出院,随访4～99个月,平均(50±37)个月.7例患肢血运良好,正常活动.1例自体大隐静脉旁路术后51个月远端吻合口及腘动脉分支狭窄,行球囊扩张术后1个月后再闭塞,经保守治疗后轻度跛行.结论 腘动脉压迫综合征是导致青少年下肢缺血的少见疾病,早期正确诊断和及时手术治疗可取得良好效果.

Abstract：

Objective To summarize our experience on the diagnosis and management of 8 patients with popliteal artery entrapment syndrome (PAES). Methods Clinical data of 8 PAES cases admitted from Jul 2002 to Jul 2010 were retrospectively analyzed. There were 7 males and 1 female with the mean age of (29 ± 14)years (ranging 16 -56 years). In 6 cases posterior "S" shaped incisions in the popliteal fossa were applied and anomalous anatomic structures were verified. Segmental stenosis and post-stenotic popliteal arterial aneurysm was identified in 2 cases, and partial resection of the aneurismal wall and arterioplasty including one with saphenous vein patch were applied; For 4 cases with short segmental occlusion of the popliteal artery, surgical treatment included thromboendarterectomy in 2 cases (with saphenous vein patch plasty in one case), saphenous vein interposition in 1 case, and saphenous vein bypass grafting in 1 case.Medial longitudinal incisions and saphenous vein bypass grafting were applied in 2 cases with long segmental occlusion in popliteal artery without exploration for anatomic anomalies. Results All patients recovered uneventfully without any notable complication. During the follow-up period ranging from 4 to 99 months [average (50± 37) months], no ischemic symptom reoccurred in 7 cases with patent arteries or grafts, and recurrent claudication occurred in 1 case with distal anastomostic stenosis. The stenosis was subsequently treated with balloon angioplasty and vein graft thrombsis occurred one month later. Medicine and exercise were recommended for the patient and now mild claudication still remains without affecting his normal life.Conclusions PAES is a disease of relatively low incidence resulting in lower extremity ischemia, which can be successfully cured with proper management.     

Popliteal artery entrapment: diagnosis by computed tomography

Popliteal artery entrapment by an anomalous band of the gastrocnemius muscle is uncommon. In cases where popliteal artery occlusion has occurred, the diagnosis is difficult to establish. A case is presented in which computed axial tomography of the popliteal space established the diagnosis of popliteal artery thrombosis caused by entrapment when other diagnostic modalities were inconclusive. Computed axial tomography provides precise anatomic display of the muscle structure of the popliteal fossa and should be an important diagnostic tool in patients suspected to have popliteal artery entrapment.     

Popliteal Artery Injury Associated With Total Knee Arthroplasty: Trends,Costs and Risk Factors

Popliteal artery injury is a relatively rare but potentially devastating complication of total knee arthroplasty (TKA). We analyzed the Nationwide Inpatient Sample from 1998 to 2009 to determine the actual incidence, risk factors and consequences of this complication. There were 1,120,508 hospitalizations coded for TKA; of these, 633 (0.057%) were identified as having a popliteal artery injury. The rate of injury remained relatively constant though the number of both TKAs and injuries have risen annually by 0.65% and 0.5%, respectively. Significant risk factors included revision surgery, peripheral vascular disease, weight loss, renal failure, coagulopathy, and metastatic cancer. Consequences were increased hospital charges, length of stay, and mortality rates. Because the rate of popliteal artery injury is not diminishing with time and morbidity and mortality are high, patients should be assessed for known risk factors for popliteal artery injury.