Popliteal aneurysm repair using the posterior approach.
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ABSTRACT:
SUBMITTER: Bowles B
PROVIDER: S-EPMC9556624 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Popliteal aneurysm repair using the posterior approach.
Bowles Bradley B Awad Mark M Smeds Matthew R MR
Journal of vascular surgery cases and innovative techniques 20220908 4
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Project description:Popliteal cysts are known to be associated with intra-articular pathology, which must be addressed to prevent cyst recurrence. Indications for popliteal cyst excision include cases in which the popliteal cyst does not respond to conservative treatment or arthroscopic intervention or cases in which an underlying cause cannot be found. Several techniques have been described to excise these cysts. Traditionally, open techniques have been associated with cyst recurrence. More recently, arthroscopic cystectomy has been described. However, the risk of recurrence persists because arthroscopy may not afford complete surgical excision. This technical note presents an open posterior technique for popliteal cyst excision that allows for better visualization and complete removal of the cyst while minimizing the risk of neurovascular complications and soft-tissue damage. It is a safe, effective, and straightforward method to achieve symptomatic relief for refractory popliteal cysts.
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Project description:Introduction. It is rare for a popliteal artery aneurysm (PAA) to present with rupture. This case reports a longer-term success in the management of a large ruptured popliteal artery aneurysm with an endovascular approach, with a literature review of management of such cases. Case Report. An 80-year-old man presented to the accident and emergency department with pain and swelling behind the left knee and at the back of the thigh. An ultrasound scan and subsequent CT angiogram revealed a large 9.4?cm ruptured PAA. The patient had significant comorbidities deeming him unfit for a major surgical intervention of drainage of haematoma and exclusion bypass. Therefore, he underwent urgent endovascular treatment of the ruptured PAA with a covered stent graft. A follow-up duplex scan at 1 year showed a patent stent with no evidence of endoleak, and the patient remained asymptomatic. A clinical follow-up at 18- and 24-month postprocedure showed a patent stent graft and complete resolution of haematoma. Conclusion. Whilst open repair with exclusion bypass may still be a treatment of choice, an endovascular approach is both safe and effective in the management of a ruptured PAA in an unfit patient with an acceptable longer-term outcome.
| S-EPMC7102448 | biostudies-literature
Project description:ObjectiveInfrarenal abdominal aortic aneurysm (AAA) and popliteal artery aneurysm (PAA) are localized arterial dilatations with distinct clinical outcomes. This study aimed to comprehensively compare these two types of aneurysms' biomechanical, histological, and immunohistochemical characteristics.MethodsThis study included 180 patients with AAA and 18 with PAA. Medical history and imaging data were collected. Biomechanical testing assessed arterial wall mechanical strength and elasticity, and histological and immunohistochemical analyses examined tissue composition and inflammatory markers.ResultsPAA wall fragments demonstrate higher failure strain energy (13.36 N/m2 vs 9.95 N/m2; P = .023), a measure of mechanical strength. Regarding immunohistochemical markers, AAA exhibited more B lymphocyte cells in the adventitia (CD20 1475.50 vs 320; P = .003) compared with PAA. Additionally, AAA demonstrated more adipogenic differentiation in the adventitia (PPARgamma 4854.50 vs 778; P = .009), whereas PAA showed more adipogenic differentiation in the intima (KLF5 283.50 vs 77.50; P = .039).ConclusionsPAA wall fragments demonstrate greater mechanical strength compared with AAA wall fragments. In contrast, AAA walls contain a greater number of B lymphocytes within the adventitia compared with PAA walls. Adipogenic differentiation is more pronounced in the adventitia of AAA than in PAA, whereas in PAA, it is more prominent in the intima compared with AAA.Clinical relevanceThe clinical significance of this study lies in its potential to enhance our understanding of the distinct pathophysiological mechanisms underlying abdominal aortic aneurysms, which is often associated with rupture, and popliteal artery aneurysms, which are more prone to thrombosis and distal embolization. By comprehensively comparing the biomechanical, histological, and immunohistochemical aspects of these two aneurysm types, the study aims to illuminate the factors contributing to their differing clinical presentations and outcomes.
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Project description:Popliteal tendon tears without concomitant damage to the cruciate ligaments or other posterolateral corner ligaments are rare entities with few studies reporting on their existence, with rare case reports discussing their treatment. Continued pain, instability, and effusions are typical symptoms, with magnetic resonance imaging being the main tool for diagnosis. Furthermore, monosodium urate crystals that induce gout have been shown to collect in the popliteal groove and thus may lead to degeneration and isolated tearing. Most case reports have reviewed arthroscopic debridement of the tendon in patients with continued pain. However, in the young athletic population, open repair, if the tissue appears to be of adequate quality, should be a consideration. The use of suture anchors to restore the popliteus to its anatomic footprint is desired. This Technical Note describes a safe and reliable technique for open popliteal tendon repair of an isolated avulsion injury.
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Project description:BackgroundThis cohort study aimed to evaluate the short- and long-term outcomes of open repair (OR) and endovascular repair (ER) and identify the most suitable graft and approach for treating popliteal artery aneurysm (PAA) patients.MethodsThe data of PAA patients from January 2000 to August 2020 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality, peri-operative complication morbidity, post-operative type II endoleak, and sac- enlargement. The secondary endpoints were primary graft patency, secondary graft patency, the reintervention rate, and overall mortality.ResultsA total of 213 PAAs of 186 patients were surgically repaired. The ER group had a significantly lower mean length of hospital stay, blood loss volume, and aneurysm diameter than the OR group. There were no significant differences between the ER and OR groups in terms of average surgery time, 30-day mortality, peri-operative complication morbidity, post-operative type II endoleak, sac enlargement, primary and secondary graft patency, reintervention rate, and overall mortality. However, in the sub-group analysis, autologous vein grafts had significantly higher primary and secondary graft patency rates than expanded polytetrafluoroethylene (ePTFE) vascular grafts and stent grafts. Type II endoleaks and post-operative sac enlargements were less likely to occur in OR patients when the posterior approach was adopted.ConclusionsWe failed to establish any difference in superiority between OR or ER. However, we found that autologous vein grafts have better graft patency and the posterior approach is less likely to lead to type II endoleaks and sac enlargements after the initial PAA surgical procedure. However, more high-quality, large-scale randomized controlled trials need to be conducted.
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