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Arteropathies, Microcirculation and Vasculitis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
There are four uncommon vascular causes of exercise-induced lower limb claudication, popliteal artery entrapment syndrome, cystic adventitial disease of the popliteal artery, fibromuscular dysplasia of the lower-extremity arteries and endofibrosis of the iliac artery. Popliteal artery entrapment is caused by an anomalous relationship between the artery and neighbouring musculotendinous structures in the popliteal fossa, resulting in extrinsic compression of the artery. Aneurysm, thromboembolism and cystic adventitial disease of the popliteal artery can result from the repetitive insult.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Popliteal artery entrapment syndrome is caused by symptomatic compression or occlusion of the popliteal artery by adjacent structures. It commonly presents in athletic males and is most frequently caused by the medial head of gastrocnemius or occasionally popliteus. It presents as intermittent claudication, which may be exacerbated by plantar flexion, or with thrombosis and can be bilateral in two-thirds. MRI is the favoured imaging modality because it demonstrates the underlying anatomy and aids surgical planning. Arterial phase CT and angiography would help to delineate the popliteal artery but the underlying soft tissue definition is better on MRI than CT. Similarly, ultrasound can help to demonstrate the artery and plantar flexion whilst scanning may reveal arterial compression, but MRI would still be favoured for surgical planning. A knee radiograph would not provide much benefit in this scenario.
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The main blood supply to the lower limb is by the femoral artery, which is the continuation of the external iliac artery. The femoral artery continues as the popliteal artery in the lower leg (Table 6.1 and Figure 6.3).
Symptomatic arterial thrombosis associated with novel coronavirus disease 2019 (COVID-19): report of two cases
Published in Acta Chirurgica Belgica, 2023
Nicolas De Hous, Paul Hollering, Ruth Van Looveren, Tu Tran, Dominik De Roover, Sven Vercauteren
The patient was initially admitted to the ICU for respiratory support (nasal oxygen) and antibiotic therapy, and both systemic anticoagulant therapy (unfractionated heparin) and catheter-directed intra-arterial thrombolysis were started. The initial angiogram showed a thrombotic occlusion of the right popliteal artery and left tibioperoneal trunk (Figure 3). Transoesophageal echocradiography (TEE) revealed no abnormalities, no cardiac arrhythmias were observed during monitoring at the ICU, and imaging of the aorta (chest CT, angiography) showed no mural thrombi or aneurysmal deformations. Therefore, an emboligenic etiology was excluded. After 72 h of thrombolytic therapy, the ischemic left foot had fully recovered, but the right foot only partially as most of the digits remained cyanotic. The control angiogram showed successful revascularization of the right popliteal artery, but a persisting occlusion of the right anterior and posterior tibial artery. A lumbar sympathectomy (radiofrequency ablation) was performed a few days later to obtain an additional vasodilatory effect. After a prolonged respiratory recovery, the patient was discharged after 2 weeks with therapeutic anticoagulation. The demarcation of non-viable tissue in the right foot was limited to 3 toes. Unfortunately, the patient was readmitted to the ICU one month later with severe urosepsis, and he eventually died of respiratory complications.
False aneurysm of the popliteal artery revealing a solitary osteochondroma of the distal femur in an 11-year-old boy
Published in Acta Chirurgica Belgica, 2022
H. Pelet, S. Tunon de Lara, C. Pfirrmann, P. Meynard, L. Harper, A. Angelliaume, X. Berard, Y. Lefèvre
The radiographic aspect of solitary osteochondroma is typical: it appears as a regular metaphyseal bone tumour with a perpendicular axis to the diaphysis [2,14]. To our knowledge, no recommendation exists for the work-up of these tumours but usually an MRI is performed to confirm diagnosis and evaluate the cartilaginous cap [2,14]. This cap normally decreases in size during adulthood [8]. For some authors this explains the false aneurysm as vessels would be eroded by the bone as the cartilage disappears [10]. Other authors hypothesise that the false aneurysm causes the necrosis of the cartilage by hyperpression [15]. In the current case, the cartilaginous cap was still present on the MRI. Surgical exploration showed it was very thick and probably did not protect the artery from the bone hook seen on the CT-scan (Figure 1). This is rather in favour of the hypothesis proposed by Greenway et al. [10]. Furthermore, the popliteal artery is more susceptible to present a false aneurysm for anatomical reasons as it is not mobile in this area. Indeed, the artery is fixed proximally by Hunter’s canal and distally by its own division into the 2 tibial arteries [11,13]; meaning it cannot slide over the osteochondroma in order to avoid conflict [10,13]. This probably explains why the knee (distal femur and proximal tibia) is the location where there are the most vascular complications of osteochondroma [6,7].
Exercise induced neuropathic lower leg pain due to a tibial bone exostosis
Published in The Physician and Sportsmedicine, 2021
Loreen van den Hurk, Marijn van den Besselaar, Marc Scheltinga
Weightbearing athletes often present with exercise induced leg pain (ELP) that is of diverse origin and occasionally difficult to diagnose. Symptoms may be ambiguous and nonspecific. A thorough history and physical examination are required as well as appropriate imaging and diagnostic tests once the diagnosis is definite [2]. Common causes of leg pain in athletes are chronic exertional compartment syndrome (CECS) and medial tibial stress syndrome (MTSS). CECS is characterized by pain and tightness that occur after a predictable period of exercise. MTSS is diagnosed as pain that is elicited following palpation of the distal portion of the tibial bone, just proximal to the medial malleolar bone. Less prevalent are tibial stress fractures that are characterized by a local pain and abnormal imaging. By contrast, popliteal artery entrapment syndrome (PAES) is suspected by a severe pain in the calf musculature following exertion that will disappear within 5 minutes of standing. Nerve entrapments may be present if skin sensation is different, for instance dorsal or plantar portions of the foot in case of peroneal nerve or tibial nerve involvement, respectively [2,3]. These conditions often have overlapping clinical presentations. In addition, symptoms may vary within a given diagnostic entity. In the present patient, not imaging but a combination of history (continuous tingling sensations) and physical examination (foot sole hypo-esthesia) provided important clues for the diagnosis.