The approach to the popliteal anatomy can be dictated by the pathology, with specific conditions unique to this mobile area. The patient was a 46yearold hypertensive male diver who had been experiencing pain in his right leg for around six months, which worsened. Types 1 and 4 are due to abnormalities in the course of the popliteal artery, while types 2 and 3 are due to an abnormal insertion of the medial head of the gastrocnemius muscle. The popliteal artery is the direct continuation of the superficial femoral artery, at the point where it exits the adductor canal at the adductor hiatus, and passes into the popliteal fossa as the vessel courses posteriorly behind the knee. The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The muscle and tendons near the knee are positioned so that they compress the popliteal artery the main artery that runs through and behind the knee. There is no replacement for good clinical judgement and the authors cannot be held liable for any mistake of harm resulting from the use of this website or its content. Popliteal artery occlusive disease is a common occurrence, especially in elderly patients, smokers, and those with diabetes mellitus and other cardiovascular diseases. Rupture of a popliteal artery aneurysm is a rare event, and few cases are described in the literature. These vascular masses may present with pain and with palpable. Feb 25, 2020 the popliteal pulse, located at the back of the knee popliteal artery, is the most challenging pulse to find in the body.
Popliteal artery entrapment syndrome presenting as acute limb ischemia in pregnancy. This is popliteal artery exposure by mark evans on vimeo, the home for high quality videos and the people who love them. The popliteal artery is the continuation of the femoral artery that begins at the level of the adductor hiatus in the adductor magnus muscle of the thigh. The fibular artery arises from the bifurcation of tibialfibular trunk into the fibular and posterior tibial arteries in the upper part of the leg proper, just below the knee.
Repair of popliteal aneurysms by posterior endoaneurysmorrhaphy and reconstruction with a short. Popliteal artery entrapment syndrome paes is an uncommon disorder caused by extrinsic anatomic compression of the popliteal artery within the popliteal fossa by muscular or ligamentous structures. To report on a case of popliteal artery entrapment that was treated surgically. The popliteal artery disappears through a hiatus in the origin of the soleus muscle. It enters the diamondshaped popliteal fossa medially and exits it laterally. The pulse is usually found in the area between the tendons of the extensor hallucis longus and extensor digitorum longus at the depression found at the midpoint of the ankle joint. Popliteal artery entrapment syndrome paes is a rare vascular disease that affects the legs of some young athletes. Its prevalence is about 1%, and patients are almost exclusively men of an age between 65 and 80 years. Peripheral arterial examination clinical examination youtube.
This technique can be used as part of a full lower limb peripheral arterial assessment. Popliteal artery aneurysm presents in a variety of ways. Each year, more than 100,000 peripheral arterial reconstructive operations and 50,000 lowerlimb amputations for lowerextremity ischemia are performed in the united states. The popliteal pulse point comes from the femoral artery, and you will find this pulse point on the back of the knee. Two different types of this anomaly can occur, complete or incomplete, on the basis of the relationship between sciatic artery and femoral artery. The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. Clinical examination and laboratory data were not helpful for diagnosis. Popliteal definition of popliteal by medical dictionary. Popliteal artery entrapment syndrome paes is a rare but potentially limbthreatening disease seen predominantly in young athletes. Ruptured giant popliteal artery aneurysm journal of vascular. Many patients are asymptomatic, while others have symptoms referable to the aneurysm such as pain with ambulation claudication or acute limb ischemia due to aneurysm thrombosis or distal embolization. Its an important vital sign, though, since the popliteal pulse can help in determining the severity and nature of a knee or femur injury. In the more heavily calcified popliteal artery, there is more curvature overall. The popliteal artery is a continuation of the femoral artery in the popliteal fossa at the rear of the knee.
The popliteal artery is the continuation of the femoral, and courses through the popliteal fossa. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the. If the femoral artery has to be ligated surgically to treat a popliteal aneurysm, blood can still reach the popliteal artery distal to the ligation via the genicular anastomosis. People are able to find it and use it to count a pulse in the back of the knee. Though a relatively rare syndrome, it is likely underdiagnosed. Feb 29, 2016 in this video we go over an important junction in the lower extremity. Take note of the appropriate areas to palpate from the head superficial temporal artery all the way down to the feet dorsalis pedis, as well as. Popliteal artery entrapment syndrome radiology reference. Popliteal pulse point palpation, location, and assessment nursing duration. Longterm results of open repair of popliteal artery aneurysm. This approach can be complicated by persistent collateral flow to the excluded aneurysm sac, which may lead to aneurysm growth, the development of compressive symptoms, and in some cases, rupture. Differential diagnosis thrombosed right popliteal artery aneurysm, bakers cyst but the color doppler features effectively rule out this possibility, pseudoaneurysm arising from the popliteal artery but the popliteal artery is not seen seperate from the mass, so this most likely represents aneurysmal dilatation of the popliteal artery. The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle.
Popliteal pulse palpation fingers and thumbs youtube. How to apply kinesiology taping for plantar fasciitis heel spur foot pain duration. Feb 11, 2015 popliteal artery aneurysm paa constitutes a rare disease in the general population. Popliteal anatomy the popliteal artery is in continuity with the superficial femoral artery. When accessing the pa, the patient is usually placed prone and thus should be able to tolerate this, and after access is achieved with a wire, the patient is repositioned supine for the cfa access and subsequent interventions.
Popliteal artery entrapment syndrome paes refers to symptomatic compression or occlusion of the popliteal artery due to a developmentally abnormal positioning of the popliteal artery in relation to its surrounding structures such as with the medial head of gastrocnemius mhg or less commonly with popliteus or fibrous bands. Poststenotic arterial dilation may lead to aneurysm formation. Popliteal artery location entrapment popliteal artery. Surgical treatment for popliteal artery entrapment. It begins where the femoral artery emerges from an opening adductor hiatus in the tendon of the adductor magnus muscle and ends where it splits into the anterior and posterior tibial arteries. It runs towards the foot in the deep posterior compartment of the leg, just medial to the fibula. Popliteal artery injury associated with blunt trauma to. A pulse of the anterior tibial artery can not be taken, but you can easily feel a pulse of the dorsal pedis artery.
Apr 15, 2020 the popliteal artery entrapment syndrome can be classified based on what caused the popliteal artery to become compressed. Popliteal artery stenosis caused by a bakers cyst journal of. Metaanalysis of open and endovascular repair of popliteal artery aneurysms. Endovascular interventions on the superficial femoral and. It enters the thigh from behind the inguinal ligament as the continuation of the external iliac artery here, it lies midway between the anterior superior iliac spine and the symphysis pubis. Anatomic landmarks include the tendinous insertion of the adductor magnus muscle in the distal femur superiorly, and the bifurcation of the popliteal artery into the anterior tibial. Affect of stenting the popliteal artery location native stented middle sfa 9% 3% distal sfaprox poplital 23% 6% popliteal 14% 11% longitudinal compression 90 degrees flexion of knee and hip nikanarov et al.
After closing plaintiffs surgical wound, the doctor releases tourniquet from plaintiffs leg and notes that plaintiff is bleeding significantly from the incision site in his knee. Blunt trauma to the lower extremity has been associated with a 28% to 46% rate of injury to the popliteal artery in the form of transection, occlusion, laceration, perforation, arteriovenous fistula, or intimal injury. May 15, 2019 popliteal artery occlusive disease is a common occurrence, especially in elderly patients, smokers, and those with diabetes mellitus and other cardiovascular diseases. The popliteal pulse, located at the back of the knee popliteal artery, is the most challenging pulse to find in the body.
The examiner should hold the leg in a mild degree of flexion. The popliteal artery is the peripheral artery which is most commonly affected by aneurysmal degeneration. Examination at that time revealed a normal left femoral pulse but no popliteal and pedal pulses were felt. The popliteal artery passes through the popliteal fossa and at the lower part of the popliteus muscle divides into its terminal branches. A large lateral branch that supplies the vastus lateralis, the biceps femoris, and the lateral aspect of the distal third of the thigh.
On the right, the superficial femoral artery was patent. Exposure was provided by performing a cut down and patching the cfaproximal sfa to the level of the stents, following which gentle. The short distal segment of the popliteal artery lies between the heads of the gastrocnemius and popliteus muscles. The prior stents had come close to the origin of the sfa and at that time there had been some narrowing. Persistent sciatic artery is a very uncommon embryologic vascular variant, with a prevalence of 0. Download premium images you cant get anywhere else. It begins where the femoral artery emerges from an opening adductor hiatus in the tendon of the adductor magnus muscle and ends where it. Constant and repeated vascular wall trauma triggers the formation of the pseudoaneurysm. Lower limb anatomy popliteal fossa, dr g bhanu prakash duration. However, if flow in the femoral artery of a normal leg is suddenly disrupted, blood flow distally is rarely sufficient. The posterior tibial artery is a direct continuation of the popliteal, passing down the lower leg to supply structures of the posterior portion of the leg and foot.
Find highquality popliteal artery stock photos and editorial news pictures from getty images. The popliteal artery supplies blood to the ligaments of the knee joint and works to maintain a blood supply to the rest of the leg. Popliteal artery injury associated with blunt trauma to the. Exposure of the popliteal artery and vein clinical gate. Popliteal artery aneurysm paa constitutes a rare disease in the general population. Ligation and bypass is the most commonly performed surgical treatment for popliteal artery aneurysm. Popliteal artery entrapment syndrome paes is a nonatherosclerotic cause of claudication and acute ischemia of the legs in young individuals.
Although rare and mostly asymptomatic, up to 20% of affected patients present acute symptoms. May 22, 2016 the short distal segment of the popliteal artery lies between the heads of the gastrocnemius and popliteus muscles. Although many of these patients are asymptomatic, it may represent a threat to the viability of the lower extremity. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Dorsal pedal pulse and posterior tibial artery st duration. The values presented on this website are provided for indicative purpose only and may contain errors. Pronunciation of popliteal artery with 1 audio pronunciation, 3 synonyms, 10 translations and more for popliteal artery. Exposure of the popliteal artery and vein is relevant to many surgical specialties, including general, vascular, and trauma. Apr 08, 2015 near the popliteal artery the popliteal vein follows and carries blood from the knee as well as the thigh and calf muscles back to the heart. Popliteal artery aneurysm vascular surgeon dr androulakakis. In this video we go over an important junction in the lower extremity.
This is intended to help clinicians who are developing their lower limb vascular assessment skills. Anatomy of the popliteal fossa everything you need to know dr. The posterior approach for repair of popliteal artery. Popliteal artery definition of popliteal artery by the.
Presented as a podium presentation at the twentyninth. Endovascular treatment of asymptomatic popliteal aneurysms. It supplies a perforating branch to both the lateral and anterior compartments of the leg. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries the deepest most anterior structure in the fossa, the popliteal artery runs close to the joint. We present an 18 yearold female avid soccer player, who complained of severe pain in both calves for over a year. It begins at the adductor hiatus, crosses the floor of popliteal fossa from the medial to lateral side to reach the lower border of the. An 84yearold male with rest pain, who had undergone prior revascularization with covered stents, represents with recurrent rest pain. The popliteal artery passes obliquely through the popliteal fossa and then travels between the gastrocnemius and popliteal muscles of the posterior. Peripheral vascular disease made easy 56,940 views. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries. A popliteal aneurysm may be defined as a popliteal artery. Popliteal artery entrapment syndrome presenting as acute limb. The vascular anatomy on the left side was unremarkable. As a continuation of the femoral superficial femoral artery as it passes into the popliteal fossa through the adductor.
Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm. If the knees are slightly flexed to about 45 degrees. Ta continuation of femoral artery in the popliteal space, bifurcating at the lower border of the popliteus muscle as it passes deep to the arcus tendineus of the soleus muscle into the anterior and posterior tibial arteries. The left posterior tibial artery pulse was palpable, but the dorsalis pedis pulse was absent. Thus, this chapter encompasses both medial and posterior approaches to the popliteal artery and. There are no major branches from this segment, and it is approachable from both the medial and lateral sides of the leg. It extends from the opening in the adductor magnus, at the junction of the middle and lower thirds of the thigh, downward and lateralward to the intercondyloid fossa of the femur, and then vertically downward to the lower border of the popliteus, where it divides into anterior and posterior tibial. Popliteal artery entrapment syndrome is a condition consisting of many symptoms, the most important of which is intermittent claudication beginning at an unusually early age. We describe a case eventually presenting as a thigh compartment syndrome but initially masked by concomitant deep venous thrombosis leading to a considerable delay in recognition and treatment. When popliteal aneurysm repair is indicated, an open surgical or endovascular approach can be used. Compression of the artery restricts blood flow to the lower leg and can. It extends from the opening in the adductor magnus, at the junction of the middle and lower thirds of the thigh, downward and lateralward to the intercondyloid fossa of the femur, and then vertically downward to the lower border of the popliteus, where it divides into anterior and.
The popliteal artery is the continuation of femoral artery. As it continues down, it runs across the popliteal fossa, posterior to the knee joint. While the patient is lying on the back, the examiners thumbs are placed on the patella, and the remaining fingers of both hands are pressed in the popliteal fossa medial to the lateral biceps femoris tendon, as demonstrated in figure 1511. Passes through the adductor hiatus and continues through the deep popliteal fossa as the popliteal artery to its bifurcation at the distal popliteal fossa or it passes through the fibrous arch of soleus m. By the term aneurysm, we mean a weak area of the artery bulging or expanding to reach over 1. Feb 27, 2016 popliteal pulse point palpation, location, and assessment nursing duration. These issues are of particular concern when accessing the popliteal artery. Popliteal artery definition of popliteal artery by medical. Popliteal artery stock pictures, royaltyfree photos. Popliteal artery definition of popliteal artery by.
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