Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report

IntroductionAdventitial cystic disease is relatively rare vascular disease, frequently occurred in the popliteal artery. No definitive treatment has been established yet.Prentation of caseA 53-year-old woman presenting intermittent claudication of the right leg was diagnosed as adventitial cystic disease of popliteal artery. Percutaneous balloon dilation yielded an immediate recurrence. The disease was successfully treated by bypass grafting utilizing the short saphenous vein to replace the part of the popliteal artery containing the adventitial cyst. No postoperative complication was found six months after surgery.DiscussionComparing to a great saphenous vein, a short saphenous vein as a material of bypass graft has a significant advantage, as only a single surgical field is necessary.ConclusionWe propose that bypass graft surgery employing a short saphenous vein is worth considering as a treatment of adventitial cystic disease at the popliteal artery.     

溶栓药物联合大腔导管抽吸治疗下肢深静脉血栓34例

目的 探究溶栓药物联合大腔导管抽吸治疗下肢深静脉血栓的临床效果。方法 前瞻性选取焦作市第二人民医院2018年6月至2020年12月下肢深静脉血栓病人68例,按照随机数字表法分组,各34例。对照组给予大腔导管抽吸治疗,观察组给予溶栓药物经腘静脉置鞘预处理联合大腔导管抽吸。比较两组治疗效果、手术前后患侧-健侧大小腿周径差、凝血纤溶指标[血清D-二聚体(D-D)、纤维蛋白降解产物(FDP)、纤维蛋白原(FIB)]、血液流变学[血红蛋白(Hb)、红细胞平均体积(MCV)、红细胞压积(HCT)、血小板压积(PCT)],并对比两组术后血栓后综合征发生率。结果 观察组总有效率(94.12%比76.47%)、术中即时血栓清除率高于对照组,血栓抽吸时间[(292.26±61.48)s比(340.53±72.39)s]短于对照组(P<0.05);两组术后1 d、术后3 d患侧-健侧大腿周径差、患侧-健侧小腿周径差小于入院时,观察组小于对照组(P<0.05);术后1 d、术后3 d两组血清D-D、FDP、FIB低于入院时,观察组低于对照组(P<0.05);两组术后1 d、术后3 d Hb低...     

彩色多普勒超声诊断腘窝囊肿的临床应用价值

目的：研究彩色多普勒超声诊断腘窝囊肿的临床应用价值。方法随机选取2014年1月—2015年12月该院收治的50例腘窝囊肿患者影像学临床资料,与患者手术和病理结果对比。分析彩色多普勒临床显像特征。结果50例患者中腘窝囊肿最小为3.3 cm×1.5 cm,最大为10.9 cm×4.9 cm;经穿刺取出黄色黏稠液体,抽取量为5~10 mL,50例患者应用彩色多普勒超声诊断腘窝囊肿临床准确率达100%。术后有4例合并出血,6例患者手术证明和关节腔相通。结论彩色多普勒超声诊断腘窝囊肿临床诊断特异性极高,诊断做到临床分型,确诊率与临床分型对于临床应用具有重要价值,值得推广应用。     

关节镜治疗老年膝关节骨关节炎合并腘窝囊肿的疗效分析

目的分析膝关节镜下治疗老年骨关节炎合并腘窝囊肿的临床疗效。 方法回顾性分析2013年7月至2015年12月间吉林医药学院附属医院收治的老年膝关节骨关节炎合并腘窝囊肿的患者50例,根据手术方式分为关节镜组（n=25）和开放手术组（n=25）,随访并比较两组患者手术时间、术中出血量、术后恢复率和囊肿复发率情况。 结果所有患者均获得随访,随访时间为8~12个月,平均（10.2±2.1）个月,随访率为100%。关节镜组患者手术时间[（30.2±3.4）min]长于开放手术组[（19.9±2.3）min],术中出血量[（4.5±1.8）ml]少于开放手术组[（38.2±8.1）ml],差异均有统计学意义（t=-12.67,t=20.31,P<0.05）,术后0级恢复率关节镜组为88%,开放手术组为80%,囊肿复发率关节镜组为4.0%,开放手术组为8.0%,差异无统计学意义。 结论关节镜治疗老年膝关节骨关节炎合并腘窝囊肿患者创伤小,术中出血少,但在提高患者术后0级恢复率、降低复发率等方面仍需大样本的研究进行检验。     

Response of the popliteal artery to treadmill exercise and stress positioning in patients with and without exertional lower extremity symptoms

ObjectiveFunctionally limiting exertional lower extremity pain and neurologic symptoms are commonly encountered in military and civilian settings. Exertional muscle compression of the popliteal artery (PA) and tibial nerve in the proximal calf (the “popliteal outlet”) can be associated with these symptoms but is rarely investigated as a cause. Exertional ankle-brachial index (EABI) and dynamic PA ultrasound imaging may be suitable to screen for this syndrome of “functional” popliteal entrapment, but neither has been rigorously studied. Our objective was to characterize the response of the PA to lower extremity exertion and dynamic ankle positioning in symptomatic and asymptomatic limbs.MethodsLimbs characterized as symptomatic (n = 29) or asymptomatic (n = 61) had duplex ultrasound PA diameter and peak systolic velocity measurements with the ankle neutral and maximally plantar flexed. EABIs were obtained at rest and 1 minute and 5 minutes after walking (5 minutes, 3 mph, 10-degree incline) and running (5 minutes, 6 mph, 0-degree incline). Significance was set at P ≤ .05. Data are expressed as mean ± standard error of the mean.ResultsPlantar flexion resulted in PA occlusion and changes in diameter and peak systolic velocity in symptomatic (three occluded, ?2.4 ± 0.34 mm, +49 cm/s) and asymptomatic (six occluded, ?1.6 ± 0.21 mm, +65 cm/s) limbs. The difference in percentage change was significant between groups only for diameter change. EABIs in both groups were similar at rest, decreased with running and walking at 1 minute, and were not fully recovered by 5 minutes. Symptomatic limbs had a greater decrease in ABI than did asymptomatic limbs with both running and walking. The decrease was greatest at 1 minute after running and significantly more pronounced in symptomatic (?0.18) than in asymptomatic (?0.02) limbs.ConclusionsEABI decrease at 1 minute after running and PA diameter decrease with dynamic ankle plantar flexion are significantly greater in limbs with than without exertional lower extremity symptoms. These noninvasive measurements may be valuable in the workup of such symptoms. PA and tibial nerve compression at the popliteal outlet may be a more frequent cause of functionally limiting exertional lower extremity pain and neurologic symptoms than previously recognized.     

Infective endocarditis and incidental popliteal artery mycotic aneurysm

A mycotic aneurysm (MA) is rarely seen and defined as a pseudoaneurysm of the vessel wall due to infective endocarditis (IE). Arterial complications are often seen as an acute ischaemia in the limbs (20–30%) and usually involve the lower limbs rather than upper limbs. Majority of MA involve brachial, femoral or popliteal arteries with their branches however, MA is rarely seen on the distal part of the popliteal artery. Popliteal artery mycotic pseudoaneurysm is rare and may imitate calf vein thrombosis. We report surgical management of a rare case of MA involving the popliteal artery and aortic valve replacement (AVR) due to IE.     

腘窝囊肿治疗的探讨

目的探讨腘窝囊肿治疗的最佳方案。方法我科在2005年2月至2010年2月间采用腘窝囊肿基底囊壁创开,翻转缝合治疗腘窝囊肿48例。经12～60个月的随访,平均随访时间2年,根据Rauschning和LindGREn分级法对手术效果进行评定。结果优30例,良13例,优良率90%。结论腘窝囊肿基底创开翻转缝合术式疗效良好,复发少。若连同原发病变治疗,更加有效防止腘窝囊肿复发。     

腘窝囊肿形成的解剖学因素

目的　探讨腘窝囊肿形成的解剖因素。 方法　对30个成人膝关节标本进行解剖：(1)观察半膜肌与腓肠肌内侧头滑液囊(GSB)是否存在,GSB与膝关节滑膜囊的关系;(2)是否存在GSB与膝关节滑膜囊的通道口;(3)向膝关节腔内注射生理盐水,观察当关节腔内压力增大后,关节内液体是否向GSB内外流。 结果　(1)所有标本均存在GSB,40%(12个)标本的GSB与膝关节滑膜腔相通,其余60%(18个)均存在与膝关节滑膜腔相关联的薄弱区;(2)当膝关节腔内压力增大时关节液流向GSB内。 结论　半膜肌与腓肠肌内侧头滑液囊(GSB)是形成腘窝囊肿的解剖基础。     

Prise en charge des faux anévrismes de l’artère poplitée associés aux ostéochondromes et ceux dus aux traumatismes des membres ou secondaires à la chirurgie orthopédique

Most published articles regarding popliteal artery pseudoaneurysms (PAPs) are case reports and in English language literature. In this context, no study with robust data was previously published. The exact epidemiology of these APs is not well-known and their management is not yet codified. We wanted to summarize the current knowledge on diagnostic and therapeutic features of PAPs as a result of limb trauma and orthopedic surgery or associated with osteochondromas. An electronic research on MEDLINE and EMBASE between 1953 and March 2015 was performed; using the key words “popliteal pseudoaneurysm”. The referenced articles were selectively read and this systematic review included 116 articles. Patient demographics; clinical presentations; diagnostic and therapeutic features were reviewed. In sum, 122 cases were analyzed. Overall young adult (average age = 30.48 ± 21.25 years old) represented the majority of the affected population with a masculine preponderance (79%). The main etiologies included femoral exostosis (63%), followed by the orthopedic surgery (25%) and direct trauma into the knee (10%). Painful swelling (44%) and/or pulsatile mass (39%) represented the most commonly presenting symptoms. The commonest radiological investigations used included arteriography (49%) and CTA (27%). The treatment was open surgical repair (85%) or endovascular stenting graft (14%). Post-therapeutic courses were often uneventful (98%). The morbidity rate was low at about 2%. The treatment of direct post-traumatic PAPs was usually open surgical repair (83%) with saphenous vein grafting. Endovascular stenting may be an ideal option for managing PAPs following orthopedic surgery (88%). Open surgery for vascular repair and maximum exostectomy must be undertaken concomitantly in the setting of APs associated with osteochondromas.     

Fluoroscopic Guided Fogarty Embolectomy for an Angio-Seal Embolism in the Popliteal Artery

The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.