Bilateral True Aneurysms of Popliteal and Posterior Tibial Arteries (original) (raw)

Aneurysm of the Popliteal Artery: Case Report

2007

Popliteal artery aneurysms lead to many dreadful conditions if left untreated. We report a case of a 63-yearold man who presented with a pain in the lower extremity as a result of a popliteal artery aneurysm. He underwent surgery through a posterior approach with saphenous vein graft interposition. The presentation, investigation and treatment of this condition is discussed.

Rare Presentation of Symptomatic Bilateral Proximal Popliteal Artery Aneurysm

International Journal of Surgery and Medicine, 2016

True Popliteal an artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE) graft, as the patient also had multiple venous perforators' involvements on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

A 33-year experience with surgical management of popliteal artery aneurysms

Journal of Vascular Surgery, 2015

This study retrospectively analyzed our 33-year experience with surgical management of popliteal artery aneurysms (PAAs), with particular attention paid to early and long-term results. Methods: From January 1981 to December 2013, 234 open surgical interventions for PAA were performed in 196 patients. Data concerning these interventions were collected in a dedicated database containing main preoperative, intraoperative, and postoperative features. Early (intraoperative and <30 days) results were analyzed for mortality, thrombosis, reintervention, and amputation rates. The follow-up program consisted of clinical and duplex ultrasound examinations at 1 month and yearly thereafter. Patients who did not accomplish follow-up examinations were interviewed by telephone. Additional data regarding long-term survival and major clinical events were obtained from the Regional Health Care database. Follow-up results were analyzed for survival, primary and secondary patency, and amputations rates. Results: Patients were predominantly males (186 [95%]), with a mean age of 68.5 6 9.9 years. The PAA was asymptomatic in 97 limbs, intermittent claudication was present in 68, and limb-threatening ischemia was present in 62. Aneurysmal rupture occurred in six patients, and venous compression with leg swelling and pain was present in one patient. The intervention consisted of aneurysmal ligation and bypass grafting in 122 interventions, aneurysmectomy with graft interposition was used in 108, and four patients underwent aneurysmectomy with an end-to-end anastomosis. An autologous vein was used in 49 interventions, and a prosthetic graft was used in 181. In 71 interventions a posterior approach was used, and in the remaining 163, a medial approach was preferred. There were two perioperative deaths, with a cumulative mortality rate of 1%. Perioperative thrombosis occurred after 18 interventions (7.7%). A successful reintervention was performed in 10 of those patients, whereas surgical thrombectomy was ineffective in one patient and leg amputation was necessary. The remaining seven patients underwent major amputation without any new surgical attempt. An adjunctive major amputation was necessary in a patient with a patent bypass for irreversible foot ischemia. The cumulative rate of amputations at 30 days was 3.8% (9 of 234 limbs). Mean duration of follow-up was 62 months (range 1-312 months). During follow-up, 31 deaths, 45 thromboses, and 10 amputations were recorded. The estimated 13-year survival rate was 50.8% (standard error [SE], 0.07%); during the same interval, primary patency, secondary patency, and limb preservation rates were 55.1% (SE, 0.05%), 68% (SE, 0.05%), and 86% (SE, 0.04%). Conclusions: Open surgical repair of PAAs provided good results in our experience, with low rates of perioperative complications and an excellent durability in the very long-term setting, representing the benchmark for alternative techniques such as endovascular repair.

Popliteal Artery Aneurysms: A Literature Review and Case Study

2018

Introduction: Popliteal artery aneurysms (PPAs) are localized and irreversible dilations of the popliteal artery walls. PPA is an uncommon condition, despite which the popliteal artery constitutes the second most frequent location for true aneurysms, second to the aorta, and is the most common location for peripheral aneurysms. It primarily affects male patients with a mean age of 65 years, its effects are mainly ischemic, and patients suffering from it require leg amputation around 7% to 20% of the times. Our goal is to present a case of PPA with subacute arterial ischemia, along with a literature review. Case study: we introduce the case of a 63 years old patient with lower limb pain and no pulse. He was diagnosed with developed subacute ischemia, and it was determined that the patient’s condition was not stable, precluding revascularization. The patient’s leg was amputated as an emergency measure. Dissecting the patient’s limb revealed the presence of PPA. Discussion: The inciden...

Popliteal aneurysms: a 10-year experience

European Journal of Vascular and Endovascular Surgery, 1998

Background: Popliteal aneurysms account for 70% of peripheral arterial aneurysms and, if untreated, pose a serious threat to the affected limb. Debate continues about the best form of treatment especially for asymptomatic lesions. Method: We reviewed the computer records and charts of patients seen at this department with a diagnosis of popliteal aneurysm over the last 10 years. Patients who had not been seen within the last year were followed-up through their G.P. Results: Twenty-four patients (M 23/F 1) presented with 40 popliteal aneurysms. The mean age was 63.5 +_9 years. Symptoms were present in 23 of the affected limbs while 17 were asymptomatic. Thirty were treated surgically and 10 followed with regular ultrasound. The mean diameter of the repaired aneurysms was 3.3 +_ 1 cm. Aneurysms <2 cm were more likely to be asymptomatic. No limbs were lost in patients undergoing elective repair of popliteal aneurysms. The secondary pateney and limb salvage rates at 3 years were 84% and 96% respectively. Conservative management of asymptomatic lesions <2 cm was not complicated by the development of symptoms.

Surgical management of popliteal aneurysms

Journal of Vascular Surgery, 1986

Graft replacement was performed for 123 (77%) of 160 popliteal aneurysms evaluated at The Cleveland Clinic from 1952 to 1984, employing autogenous saphenous vein in 58 (36%), polytetrafluoroethylene in 19 (12%), and of historic interest, Dacron (12%) or arterial homograft (16%) in 46. The 10-year cumulative patency (CP) rate was 56% and the limb salvage (LS) rate was 83% following graft replacement, but late results were superior in patients who received vein bypass (CP, 94%; LS, 98%), in those who underwent revascularization before ischemic complications had occurred (CP, 92%; LS, 96%), and in those who recovered both pedal pulses (CP, 64%; LS, 96%). Long-term asymptomatic limbs were restored in 96%, 92%, and 89% of these subsets, respectively, compared with 65% of those receiving other graft materials (p = 0.00003), 59% of those with preoperative ischemic symptoms (p = 0.00001) and 68% of those regaining only an isolated popliteal pulse (p = 0.0326). These data indicate that popliteal aneurysms should be corrected by vein bypass to a patent tibioperoneal segment before spontaneous thrombosis or embolization eliminates the critical outflow bed. (J VAse St3RG 1986; 3:125-34.)

A rare case of dual true aneurysms of unilateral popliteal artery

Turkish journal of vascular surgery, 2019

Popliteal artery aneurysm is the most common form of arterial aneurysms in the peripheral arterial system. An 86-year-old male patient with dual true aneurysms in the unilateral popliteal artery presented with leg pain without any ischemic physical signs. A proximal 20.1¥17.9-mm saccular aneurysm was treated with a 9¥100-mm endovascular stent graft, and a distal 50.6¥54.2-mm fusiform aneurysm was treated with a 10¥100-mm endovascular stent graft. In conclusion, although surgical treatment is the gold standard, endovascular treatment should be considered as an alternative method with several benefits in high-risk patients.

Surgical management of popliteal artery aneurysms: Which factors affect outcomes?

Journal of Vascular Surgery, 2006

Objective: Popliteal artery aneurysm (PAA) is uncommon. The clinical presentation of PAA includes rupture, embolism, and thrombosis. In this article, we evaluate the results of our 20-year experience with surgical management of PAAs, analyzing the role of anatomic, clinical, and surgical factors that potentially affect early and long-term results. Methods: From January 1984 to December 2004, 159 PAAs in 137 patients were operated on at our department. Data from all the patients were retrospectively collected in a database. PAAs were asymptomatic in 67 cases (42%); 5 (3%) PAAs were ruptured. In 51 cases (32%), PAA caused intermittent claudication. The remaining 36 limbs (23%) had threatening ischemia due in 30 cases to acute PAA thrombosis, in 4 cases to chronic PAA thrombosis, and in 2 cases to distal embolization. In selected patients with acute ischemia, preoperative intra-arterial thrombolysis with urokinase was performed. Early results in terms of mortality, graft thrombosis, and limb salvage were assessed. Follow-up consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Long-term survival, patency, and limb salvage rates were analyzed. Results: Forty cases were treated with aneurysmectomy and prosthetic graft interposition; in 39 cases, the aneurysm was opened, and a graft was placed inside the aneurysm. Four patients had aneurysmectomy with end-to-end anastomosis. In 73 cases, ligation of the aneurysm with bypass grafting (39 with a prosthetic graft and 34 with an autologous vein) was performed. The remaining three patients underwent endovascular exclusion of their PAAs. A medial approach was used in 97 patients (61%), and a posterior approach was used in 59 patients (37.1%). The outflow vessel was in most cases (93.7%) the below-knee popliteal artery. Thirty-day amputation and death rates were 4.4% (7/159 limbs) and 2.1% (3/137 patients), respectively. The amputation rate was significantly higher in symptomatic limbs than in asymptomatic ones (6.5% and 1.4%, respectively; P ‫؍‬ .05). Eight limbs (5%) had an early graft thrombosis that required a reintervention. . The cumulative estimated 60-month survival, limb salvage, and primary and secondary patency rates were 84.2%, 86.7%, 66.3%, and 83.6%, respectively. Asymptomatic limbs had significantly better results than symptomatic ones in terms of limb salvage (93.4% and 80.4%, respectively; P ‫؍‬ .03; log-rank, 4.2) and primary patency (86.5% and 51.6%, respectively; P ‫؍‬ .001; log-rank, 10.3). Among symptomatic patients, results were better in claudicant limbs than in acutely ischemic ones in terms of limb salvage (90.5% and 58.7%, respectively; P ‫؍‬ .001; log-rank, 17.5). Univariate analysis showed the absence of symptoms, the presence of two or three tibial vessels, the use of a posterior approach, the kind of intervention, and the site of distal anastomosis to significantly affect long-term patency. Cox regression for factors affecting 60-month primary patency showed that clinical presentation, runoff status, and the site of distal anastomosis significantly influenced long-term results. Conclusions: Results of surgery on asymptomatic PAAs are good-significantly better than those for symptomatic ones. Elective surgical intervention should be performed in patients with a low surgical risk and a long life expectancy when the correct indication exists. In thrombosed aneurysms, intra-arterial thrombolysis may represent an alternative to emergent surgical management. Our data demonstrated that results are similarly good in claudicants, and this fact confirms that only acute ischemia due to PAA thrombosis represents a real surgical challenge. In selected patients with focal lesions, a posterior approach seems to offer better long-term results. The runoff status and the site of distal anastomosis affect long-term patency as well. ( J Vasc Surg 2006;43:481-7.)

Small popliteal artery aneurysms: Are they clinically significant?

Journal of Vascular Surgery, 2003

Objective: We undertook this study to determine whether popliteal artery aneurysm diameter correlates with initial symptoms and presence of associated occlusive disease. Methods: Duplex arteriography before infrainguinal revascularization in 500 lower extremities enabled diagnosis of 34 popliteal aneurysms in 25 patients (24 male, 1 female) over the last 4 years. Fourteen patients (41%) had no symptoms (group 1) and 20 (59%) had symptoms (group 2) of severe claudication (n ‫؍‬ 8), acute ischemia (n ‫؍‬ 6), rest pain (n ‫؍‬ 2), and tissue loss (n ‫؍‬ 4). We compared clinical presentation with popliteal artery diameter, prevalence of thrombosis, and presence of associated occlusive disease. Results: Popliteal artery aneurysm diameter averaged 2.8 ؎ 0.7 cm (range, 1.8-4.5 cm) in group 1 and 2.2 ؎ 0.8 cm (range, 1.3-4.0 cm) in group 2 (P < .03). Popliteal aneurysm thrombosis was present in 7 of 20 limbs in group 2. Four of these patients also had ipsilateral superficial femoral artery thrombosis. Evaluation of the infrapopliteal arteries in group 1 showed three-vessel runoff in 7 limbs, two-vessel runoff in 3 limbs, one-vessel runoff in 2 limbs, and no vessel runoff in 2 limbs. However, all infrapopliteal arteries were either occluded or significantly stenotic in 14 limbs (70%). In group 2, one-vessel runoff was observed in 5 limbs, and two-vessel runoff in 1 limb. Conclusions: Smaller popliteal artery aneurysm was associated with higher incidence of thrombosis, clinical symptoms, and distal occlusive disease. Liberal use of duplex scanning in this setting may have accounted for the increased awareness that small popliteal artery aneurysms can thrombose and present with severe ischemia. (J Vasc Surg 2003;37:755-60.)