Popliteal artery aneurysm
Updates to Article Attributes
Body
was changed:
A poplitealPopliteal artery aneurysm is the most common peripheral arterial aneurysm and the 2nd most common aneurysm after abdominal aortic aneurysms 3.
They can either be true of false aneurysms:
- true aneurysms of the popliteal artery are usually the result of atherosclerosis or arteriomegaly.
- false aneurysms are usually the result of knee trauma, surgery/intervention or infection.
Epidemiology
Overall uncommon. There is a strong association with abdominal aortic aneurysms: 30 to 50% of patients with a popliteal artery aneurysm have a AAA, though only 10 to 14% of patients with AAA have popliteal artery aneurysms. They are bilateral in 50 to 70% of cases. There is an increased incidence with age and a strong male preponderance (M:F ratio 10 to 30:1)
Clinical presentation
- asymptomatic incidental finding
- pulsatile mass
- may present with complications (see below)
Radiographic features
Ultrasound
- often the initial imaging modality of choice 4
CT angiography
- useful for assessment of vessels distal to the aneurysm
MR angiography
- to be added
Conventional angiography
Angiography can directly show mural calcification and aneurysmal dilatation. In about 25% of cases, conventional angiography does not demonstrate aneurysmal dilatation due to thrombosis formation within the aneurysmal sac. Instead, it appears as an acute bend in the course of the popliteal artery at the level of the knee joint. This secondry sign is called "dog leg" sign 5.
Complications
- distal thromboembolism (commonest
-: occurs in 18 to 31% of untreated cases) - rupture (rare)
- pressure effects if large enough
Treatment
Symptomatic aneurysms are treated. Asymptomatic aneurysms greater than 2 cm diameter also considered for elective treatment.
Treatment methods
-
endovascular insertion of covered stent:
:flexible soft device (such as Viabahn stent graft) has better outcome due to movement at the knee crease; 5 year patency rate for Viabahn stent graft is 70%; disadvantages include kinking or fracture of stent due to excessive movement. - open surgical repair (usually aneurysmorrhaphy and bypass surgery): vein graft typically used; 5 year patency rate of vein graft is also 70%
Differential diagnosis
The differential - (mainly clinical due to transmitted pulsations of the popliteal artery) include:
- popliteal cyst (Morant Baker' Cyst)
- other cystic masses in the popliteal masses like synovial sarcoma
-<p>A <strong>popliteal artery aneurysm</strong> is the most common <a href="/articles/peripheral-arterial-aneurysm">peripheral arterial aneurysm </a>and the 2<sup>nd</sup> most common aneurysm after abdominal aortic aneurysms <sup>3</sup>.<a href="/articles/true_aneurysm"> </a></p><p>They can either be <strong>true</strong> of <strong>false</strong> aneurysms</p><ul>- +<p><strong>Popliteal artery aneurysm</strong> is the most common <a href="/articles/peripheral-arterial-aneurysm">peripheral arterial aneurysm </a>and the 2<sup>nd</sup> most common aneurysm after abdominal aortic aneurysms <sup>3</sup>.</p><p>They can either be <strong>true</strong> of <strong>false</strong> aneurysms:</p><ul>
-<a href="/articles/true_aneurysm">true aneurysms</a> of the <a href="/articles/popliteal-artery">popliteal artery</a> are usually the result of atherosclerosis or arteriomegaly. </li>- +<a href="/articles/true-aneurysm">true aneurysms</a> of the <a href="/articles/popliteal-artery">popliteal artery</a> are usually the result of atherosclerosis or arteriomegaly. </li>
-<a href="/articles/false_aneurysm">false aneurysms</a> are usually the result of knee trauma, surgery/intervention or infection.</li>-</ul><p> </p><h4>Epidemiology</h4><p>Overall uncommon. There is a strong association with <a href="/articles/abdominal_aortic_aneurysm">abdominal aortic aneurysms</a> : 30 to 50% of patients with a popliteal artery aneurysm have a AAA, though only 10 to 14% of patients with AAA have popliteal artery aneurysms. They are bilateral in 50 to 70% of cases. There is an increased incidence with age and a strong male preponderance (M:F ratio 10 to 30:1)</p><p> </p><h4>Clinical presentation</h4><ul>- +<a href="/articles/false-aneurysm">false aneurysms</a> are usually the result of knee trauma, surgery/intervention or infection.</li>
- +</ul><p> </p><h4>Epidemiology</h4><p>Overall uncommon. There is a strong association with <a href="/articles/abdominal-aortic-aneurysm">abdominal aortic aneurysms</a>: 30 to 50% of patients with a popliteal artery aneurysm have a AAA, though only 10 to 14% of patients with AAA have popliteal artery aneurysms. They are bilateral in 50 to 70% of cases. There is an increased incidence with age and a strong male preponderance (M:F ratio 10 to 30:1)</p><h4>Clinical presentation</h4><ul>
-</ul><p> </p><h4>Radiographic features</h4><h5>Ultrasound </h5><ul><li>often the initial imaging modality of choice <sup>4</sup>-</li></ul><h5>CT angiography </h5><ul><li>useful for assessment of vessels distal to the aneurysm</li></ul><h5>MR angiography </h5><ul><li>to be added</li></ul><h5>Conventional angiography</h5><p>Angiography can directly show mural calcification and aneurysmal dilatation. In about 25% of cases, conventional angiography does not demonstrate aneurysmal dilatation due to thrombosis formation within the aneurysmal sac. Instead, it appears as an acute bend in the course of the popliteal artery at the level of the knee joint. This secondry sign is called "dog leg" sign<sup> 5</sup></p><h4>Complications</h4><ul>-<li>distal thromboembolism (commonest - occurs in 18 to 31% of untreated cases)</li>- +</ul><h4>Radiographic features</h4><h5>Ultrasound </h5><ul><li>often the initial imaging modality of choice <sup>4</sup>
- +</li></ul><h5>CT angiography </h5><ul><li>useful for assessment of vessels distal to the aneurysm</li></ul><h5>MR angiography </h5><ul><li>to be added</li></ul><h5>Conventional angiography</h5><p>Angiography can directly show mural calcification and aneurysmal dilatation. In about 25% of cases, conventional angiography does not demonstrate aneurysmal dilatation due to thrombosis formation within the aneurysmal sac. Instead, it appears as an acute bend in the course of the popliteal artery at the level of the knee joint. This secondry sign is called "dog leg" sign<sup> 5</sup>.</p><h4>Complications</h4><ul>
- +<li>distal thromboembolism (commonest: occurs in 18 to 31% of untreated cases)</li>
-<strong>endovascular insertion of covered stent</strong>: flexible soft device (such as Viabahn stent graft) has better outcome due to movement at the knee crease; 5 year patency rate for Viabahn stent graft is 70%; disadvantages include kinking or fracture of stent due to excessive movement.</li>- +<strong>endovascular insertion of covered stent:</strong> flexible soft device (such as Viabahn stent graft) has better outcome due to movement at the knee crease; 5 year patency rate for Viabahn stent graft is 70%; disadvantages include kinking or fracture of stent due to excessive movement.</li>
-<strong>open surgical repair</strong> (usually aneurysmorrhaphy and bypass surgery) : vein graft typically used ; 5 year patency rate of vein graft is also 70%</li>-</ul><h4>Differential diagnosis</h4><p>The differential - (mainly clinical due to transmitted pulsations of the popliteal artery) include</p><ul>- +<strong>open surgical repair</strong> (usually aneurysmorrhaphy and bypass surgery): vein graft typically used; 5 year patency rate of vein graft is also 70%</li>
- +</ul><h4>Differential diagnosis</h4><p>The differential (mainly clinical due to transmitted pulsations of the popliteal artery) include:</p><ul>
References changed:
- 3. Goncu T, Tiryakioglu O, Sezen M et-al. Giant popliteal aneurysm with deep vein thrombosis, foot drop and arteriomegali. BMJ Case Rep. 2009;2009 (jun04 1): . <a href="http://dx.doi.org/10.1136/bcr.11.2008.1248">doi:10.1136/bcr.11.2008.1248</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027878">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/21686392">Pubmed citation</a><span class="auto"></span>
- 3. Goncu, Tugrul; Tiryakioglu, Osman; Sezen, Mustafa; Yavuz, Senol. Giant popliteal aneurysm with deep vein thrombosis, foot drop and arteriomegali BMJ Case Reports. 2009 <a href="http://dx.doi.org/10.1136/bcr.11.2008.1248">doi:10.1136/bcr.11.2008.1248</a> -<div class="ref_v2"></div>
Images Changes:
Image 1 CT (C+ portal venous phase) ( update )
Caption
was changed:
Case 1: Bilateral
Image 8 MRI (Gradient Echo) ( update )
Caption
was changed:
Case 3 -: giant aneurysm on MRI
Unable to process the form. Check for errors and try again.