Materiały źródłowe

• #1 Popliteal Artery Aneurysm – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430863/

  Popliteal artery aneurysms occur when the diameter of the popliteal artery undergoes focal dilation, exceeding 50% of its normal range, which typically varies from 0.7 to 1.1 cm. […] The etiology of popliteal artery aneurysms and general aneurysms is unknown. Molecular studies suggest that a combination of genetic defects and inflammatory processes are responsible. Atherosclerosis tends to increase flow turbulence distal to a stenosis, leading to a pathological dilation of the artery. According to current research, decreased wall strength associated with inflammatory cell infiltration results in aneurysm formation.

• #2 Popliteal artery aneurysm – Wikipedia

  https://en.wikipedia.org/wiki/Popliteal_artery_aneurysm

  A PAA is diagnosed when a focal dilation greater than 50% of the normal vessel diameter is found (the normal diameter of a popliteal artery is 0.7-1.1 cm). […] The cause of these aneurysms is unknown, but they are more common in older people and men and occur in both legs about 50% of the time. […] A PAA seldom presents with a size greater than 5cm, as symptoms typically develop before the aneurysm reaches such a size. Unlike aneurysms elsewhere in the body, the typical course of PAAs is to embolize and produce ischaemia, rather than to progress to rupture.

• #3 Popliteal artery aneurysms | Medicine Today

  https://medicinetoday.com.au/mt/2017/december/regular-series/popliteal-artery-aneurysms

  Popliteal artery aneurysms are rare but are associated with increased mortality and limb loss once patients become symptomatic. Surgical intervention is considered for medically fit patients with a popliteal artery aneurysm when the artery reaches at least 20 mm in diameter. […] Apopliteal aneurysm is defined as a popliteal artery that is at least 1.5 times the diameter of the proximal segment of the same vessel. However, as the entire arterial system is often enlarged a comparison between one segment and another may not be helpful; the most common size of popliteal artery is between 5 and 11mm in diameter based on sex and body size so theoretically even an 8mm popliteal artery could be considered aneurysmal in some people. According to most authors, the popliteal artery should be a minimum of 12mm in diameter to qualify as an aneurysm. In other words the popliteal artery should be at least 50% larger than the healthy one and at least 12mm in diameter.

• #4

  https://www.scirp.org/journal/paperinformation?paperid=108635

  Popliteal aneurysm is defined as a dilation of the popliteal artery greater than 20 mm, or greater than 50% to the diameter of the native artery. […] In its pathogenesis, arteriosclerosis seems to play an important role by weakening the arteries and their capacity for resistance. […] Cardiovascular risk factors such as high blood pressure, tobacco, diabetes, obesity seem to play an important role in the onset of this disease. […] The primary goal of surgical treatment for PAA is the prevention of thromboembolic events, which can be complicated by limb ischemia and tissue loss. […] The second objective is to avoid their increase in volume responsible for compressive phenomena or even exceptional rupture. […] Most lesions of the popliteal artery are located near the joint space. […] The therapeutic indications, in a patient with a popliteal aneurysm, should be made taking into account several factors: knowledge of the natural history of popliteal aneurysms; the nature of the lesion defined by Doppler ultrasound and angiography; the asymptomatic or symptomatic nature of the popliteal aneurysm; the presence of clinical complications pain, nerve or nerve compression; the occurrence of acute ischemia. […] The endovascular approach is a more recent alternative which consists in placing inside the aneurysm of a self-expanding covered endoprosthesis making it possible to exclude the aneurysm while ensuring the patency of the popliteal axis and the distal vasculature.

• #5 Popliteal artery aneurysm – UpToDate

  https://www.uptodate.com/contents/popliteal-artery-aneurysm

  Popliteal artery aneurysms are true aneurysms involving all layers of the vessel wall (intima, media, adventitia). […] Pseudoaneurysm formation in the popliteal artery has also been described but is rare. […] Popliteal artery aneurysms are described as fusiform (ie, diffusely dilated) or saccular (ie, rounded and typically asymmetric). Fusiform dilation of the popliteal artery may be contiguous with fusiform dilation of the superficial femoral artery. […] Aneurysm shape may have clinical implications.

• #6 Popliteal artery aneurysm | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/popliteal-artery-aneurysm?lang=us

  Popliteal artery aneurysms are the most common peripheral arterial aneurysm and the second most common aneurysm after abdominal aortic aneurysms. […] Popliteal artery aneurysms are bilateral in 50 to 70% of cases. Their location at the knee point, an area of repeated flexion, may be contributory. They can either be true or false aneurysms: true aneurysms of the popliteal artery (commonest) are usually degenerative. False aneurysms result from trauma, surgery/intervention, or infection.

• #7 Right idiopathic popliteal aneurysm in a 5-year-old boy: Case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2524-177X2021000200075

  However, isolated idiopathic popliteal artery aneurysms are exceptionally rare in the pediatric population. […] If surgical repair is not performed, popliteal artery aneurysms can lead to several severe complications. […] A true aneurysm involves symmetrical dilation of all three layers of blood vessels while preserving the histological structure. […] True aneurysms are commonly caused by atherosclerosis and hypertension; however, this only applies to the adult population. […] Following this classification, the aneurysm of the patient under study was classified as type VIII, since he had no family history of connective tissue diseases, autoimmune vasculitis, history of trauma, and rheumatic fever or Kawasaki disease. […] Aneurysms may manifest as asymptomatic or present as a pulsatile mass with shivering, local pain and ischemic pain.

• #8 Popliteal artery aneurysms | Medicine Today

  https://medicinetoday.com.au/mt/2017/december/regular-series/popliteal-artery-aneurysms

  There is also a difference between a false and a true aneurysm. False aneurysms are less common than true aneurysms and are most likely to be a consequence of trauma or iatrogenic injury. In these individuals, the enlarged segment of the vessel does not contain all the arterial layers that are present in true aneurysms. […] Popliteal artery aneurysms, unlike abdominal aortic aneurysms, tend to thrombose or embolise rather than rupture. […] The risk of limb loss is quite significant and major amputation has been reported in 14% of patients with popliteal artery aneurysms in a large systematic review of almost 900 patients. […] The size of the aneurysm increases over time at a rate of between 0.7 and 3.7mm per year according to some experts, based on the initial diameter (the larger the popliteal artery aneurysm the faster the growth). Interestingly, thromboembolic episodes do not particularly correlate with size. Larger popliteal artery aneurysms tend to cause local compression and the risk of rupture is small even in the largest popliteal artery aneurysms between 0.1 and 2.8%.

• #9 SciELO Brazil – Idiopathic popliteal artery pseudoaneurysm: emergency diagnosis and treatment Idiopathic popliteal artery pseudoaneurysm: emergency diagnosis and treatment

  https://www.scielo.br/j/jvb/a/YJnXJ6ZP4yQCRqV8JmTVqPq/

  Pseudoaneurysms or false aneurysms of the popliteal artery are uncommon arterial disorders. These disorders most commonly result from trauma and iatrogenic lesions following orthopedic procedures. […] Pseudoaneurysms of the popliteal artery (PPAs) are uncommon and there are a variety of etiologies described in the literature, with associations often described with traumatisms, infections and iatrogenic injuries after orthopedic procedures. […] PPAs are habitually the result of sequelae from injuries to the artery wall. They rarely occur in civil settings and the most important element in their genesis is traumas, whether by explosions, penetrating weapons or from iatrogenic causes. […] During etiologic investigation, the hypothesis of trauma should be investigated with great insistence and should not be undervalued, even if the trauma happened many years before or there were no significant osteomuscular injuries.

• #10 Popliteal artery aneurysm – UpToDate

  https://www.uptodate.com/contents/popliteal-artery-aneurysm/print

  Popliteal artery aneurysms are true aneurysms involving all layers of the vessel wall (intima, media, adventitia). […] Pseudoaneurysm formation in the popliteal artery has also been described but is rare. […] Popliteal artery aneurysms are described as fusiform (ie, diffusely dilated) or saccular (ie, rounded and typically asymmetric). Fusiform dilation of the popliteal artery may be contiguous with fusiform dilation of the superficial femoral artery.

• #11 Popliteal Artery Aneurysms – Endovascular Today

  https://evtoday.com/articles/2003-nov/1103_08.html

  Popliteal artery aneurysms are the most common peripheral artery aneurysms, comprising 70% to 85% of the total aneurysms in the periphery. […] Atherosclerosis appears to be the etiology in more than 90% of cases. The true pathogenesis behind popliteal artery aneurysm formation is not known, and factors such as turbulence distal to the relative stenosis at the tendinous hiatus of the adductor magnus and repeated flexion at the knee have been postulated; this does not, however, account for the association with aneurysms in other locations or the male preponderance. […] Several studies have suggested that these aneurysms have a higher rate of thromboembolism than larger aneurysms. This would suggest that the threshold for operative intervention should be lower than the current guidelines and some investigators advocate operating on all popliteal artery aneurysms.

• #12 Popliteal artery aneurysm – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-aneurysm/symptoms-causes/syc-20355432

  A popliteal artery aneurysm is an irregular bulge that occurs in the wall of the artery located behind the knee joint. […] An aneurysm is a ballooning in a weak spot in an artery wall. Many different things can cause the popliteal artery wall to become weak, including: Atherosclerosis. High blood pressure. Wear and tear of the popliteal artery due to repeat use of the knee joint. […] Complications of popliteal artery aneurysm include blood clots. Blood clots can cause a severe lack of blood flow in the lower leg. […] Smoking and high blood pressure increase the risk of blood vessel problems that can lead to popliteal artery and other aneurysms. Following a heart-healthy lifestyle can help prevent heart disease and blood vessel damage.

• #13 Blue Toe Sign as the Initial Manifestation of a Popliteal Artery Aneurysm | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-blue-toe-sign-as-initial-articulo-S1578219011000357

  Blue toe syndrome (BTS) is defined as the development of a blue or violaceous discoloration of 1 or more toes in the absence of trauma, serious cold-related injury, or alterations that could cause diffuse cyanosis. […] The results of additional tests performed to determine the etiology and pathogenesis of the aneurysm were not consistent with a diagnosis of Marfan syndrome, leading us to consider that the aneurysm might be atheromatous in origin. […] Our patient presented acute reduction of arterial perfusion due to the occlusion of arteriolar vessels by emboli arising from a mural thrombus in a popliteal artery aneurysm. Although relatively rare, popliteal artery aneurysm is the most common peripheral arterial aneurysm and it is associated with aneurysmal disease at other sites in up to 45% of patients.

• #14

  https://www.scielo.br/j/rcbc/a/6PXZp9byK5jBXKXKmzZY67S/

  Despite the promising scenario, there are still many concerns about problems observed in the short and long term. These problems are the result of the variables that were considered in this study. […] Considering the pathophysiology of silent microembolization quoted above, the evaluation of the distal arterial territory is deemed an important topic for the durability of the endovascular repair, because the greater the presence of patent distal arteries, the lower the chance of stent occlusion. […] The femoropopliteal axis is a region subject to continuous stress and twisting forces that can compromise the performance and durability of stents. […] In our study, we did not identify any cases of stent fracture; however, there was no active search protocol by radiographs of the treated region. […] In our study, there was no leakage (endoleak). […] It is believed that with the development of new devices that support the mechanical characteristics found on the popliteal region, there will be improvement in the performance and outcome of endovascular restoration in the near future.

• #15 Evaluation, Diagnosis and Management of Popliteal Artery Aneurysms: A Clinical Review | Aguila | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/174/120

  Aneurysmal disease of the popliteal artery is more common than historically thought with most of the cases going unrecognized, many times until ischemic symptoms to the leg brings it to the physicians attention. […] The common pathophysiological defect where most of the etiologies converge seems to be degeneration of the artery media through a variety of mechanisms including metalloproteinases. […] The etiologic factors associated with PAA are most commonly atherosclerosis and post-obstructive angioectasia. Infectious processes are less frequent but remain a well documented etiology factor. Regardless of the etiology, common pathophysiologic factors found include media and adventitial degeneration by metalloproteinases and depletion of smooth muscle cells. […] Multiple pathophysiological paths eventually confluence to weakening the media layer or the vessel through degradation of elastin and collagen, matrix metalloproteinases and oxygen radicals play a central role on this.

• #16 Conservative treatment of giant popliteal aneurysm with edoxaban in an elderly man

  https://www.imrpress.com/journal/JMCM/3/1/10.31083/j.jmcm.2020.01.005/htm

  Popliteal aneurysm (PA) is the most frequently occurring peripheral artery aneurysm. Male sex, older age, smoking, arterial hypertension, and cardiovascular disease are the main risk factors. PA is frequently associated with contralateral and abdominal aneurysms. […] The optimal management strategy for unoperated PA and of thromboembolism prophylaxis in high-risk patients remains unsettled. We decided to treat our patient with 30 mg of edoxaban daily, to reduce the risk of thrombosis and distal embolism. […] Edoxaban inhibits the intrinsic factor Xa (FXa), a protease that enzymatically cleaves prothrombin to form activated thrombin. A recent study has shown that FXa can inhibit the expression of proteins associated with the pathogenesis of aortic artery aneurysm, such as proteins linked to oxidative stress, and exhibits anti-inflammatory properties and has direct radical scavenging activity. These findings indicate a probable role for FXa in the pathogenesis of aneurysms. Perhaps, a better understanding of the role of FXa in aneurysms in the future may create new opportunities and possibilities for the use of direct FXa inhibitors.

• #17 Popliteal Artery Aneurysms

  https://vascularinstitute.com/blog/8731/Popliteal-Artery-Aneurysms

  Popliteal artery aneurysm (PAA) is the dilation and thinning of the popliteal artery which can occur at any point in the posterior distal thigh or knee. The ballooning of the artery can occur through a variety of etiologies consider concurrent cardiovascular disease, autoimmune status, or inflammatory state. […] Risk factors associated with PAA include: – smoking – male sex – hypertension – increased age – high cholesterol. […] Rupture of the aneurysm is a rare complication of PAA, with an occurrence of 2-5% according to some sources. This can lead to uncontrollable bleeding in the popliteal space, which presents as a massively swollen leg with anemia on laboratory findings. […] While a rare complication of PAA (reported in 2-5% in some sources), rupture of the aneurysm may be life-threatening.

• #18 Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms

  https://www.vsijournal.org/journal/view.html?uid=1196&vmd=Full

  Popliteal artery aneurysm (PAA) is a rare type of peripheral artery aneurysm that is usually detected incidentally on computed tomography or ultrasonography. PAA can also cause sudden distal thrombotic and embolic occlusion, which is potentially limb-threatening. Typically, PAA may be the finding of a prominent pulsatile popliteal mass, and compression of the nerve or vein by an enlarging PAA may cause numbness, pain, and edema. […] PAA is usually caused by atherosclerosis but may also result from trauma, congenital disorder, mycotic infection, or inflammatory arteritis. PAA is more common in men over 60 years of age with a history of cardiovascular disease and may be bilateral and associated with thoracic or abdominal aortic aneurysm. […] Compression related symptoms, such as numbness, pain, and edema, may occur if nerve and venous tissues are compressed by an enlarging giant popliteal aneurysm in a relatively small compartment.

• #19 Popliteal artery aneurysm | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/popliteal-artery-aneurysm

  A popliteal artery aneurysm is an irregular bulge that occurs in the wall of the artery located behind the knee joint. It is a type of lower extremity aneurysm. […] An aneurysm is a ballooning in a weak spot in an artery wall. Many different things can cause the popliteal artery wall to become weak, including: Atherosclerosis. High blood pressure. Wear and tear of the popliteal artery due to repeat use of the knee joint. […] Complications of popliteal artery aneurysm include blood clots. Blood clots can cause a severe lack of blood flow in the lower leg. […] Smoking and high blood pressure increase the risk of blood vessel problems that can lead to popliteal artery and other aneurysms. […] Treatment of popliteal artery aneurysm depends on: The size of the aneurysm. The symptoms. Your age and overall health.

• #20 Blue Toe Sign as the Initial Manifestation of a Popliteal Artery Aneurysm | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-blue-toe-sign-as-initial-articulo-S1578219011000357

  The most feared complication of popliteal artery aneurysm is acute distal ischemia of the limb after a thrombotic event within the aneurysm. Such ischemia can affect the lower leg below the knee if the thrombus completely occludes the popliteal artery. However, if microemboli block distal arteries or arterioles, the condition will affect a more limited area of the limb, giving rise to blue toe syndrome and other changes. […] We present a patient with blue toe syndrome or, as we propose, blue toe sign caused by embolism from a popliteal artery aneurysm, an etiology rarely reported for this syndrome.

• #21 Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00514-7

  An interesting finding of our study is the independent association of number of patent tibial arteries (pTA) with long-term survival during follow-up. […] PAA rupture is not uncommon and accounts for nearly one fifth of cases requiring urgent treatment, often associated with low long-term survival rates.

• #22 Popliteal artery aneurysm | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/popliteal-artery-aneurysm?embed_domain=hackmd.io%25252525252f%252525252540yipuafecsl2jsu8smr5njq%25252525252fbnjhjgjghjghjgh&lang=us

  Popliteal artery aneurysms are the most common peripheral arterial aneurysm and the second most common aneurysm after abdominal aortic aneurysms. […] Popliteal artery aneurysms are bilateral in 50 to 70% of cases. Their location at the knee point, an area of repeated flexion, may be contributory. They can either be true or false aneurysms: true aneurysms of the popliteal artery (commonest) are usually degenerative. […] False aneurysms result from trauma, surgery/intervention, or infection.

• #23

  https://www.scielo.br/j/rcbc/a/6PXZp9byK5jBXKXKmzZY67S/

  The popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, accounting for 70% of all aneurysms. Its highest incidence occurs in males. It is bilateral in 50% of cases, and is associated with abdominal aortic aneurysms in 60%. The pathogenesis is multifactorial. […] Although there is a risk of rupture, it is rare. Symptomatic patients have complaints resulting from acute ischemia, caused by thrombosis of the aneurysm, or chronic ischemia by distal embolization. Both presentations are related to a significant risk of limb loss. […] The classical treatment of popliteal artery aneurysm is the exclusion of the aneurysm with interposition of autologous or synthetic graft or bypass. […] As in other vascular diseases, the endovascular technique is an alternative that has been experienced in the correction of popliteal artery aneurysms.

• #24 Right idiopathic popliteal aneurysm in a 5-year-old boy: Case report

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2524-177X2021000200075

  We describe the case of a 5-year-old boy with an idiopathic popliteal artery aneurysm on the right leg, who presented the first clinical manifestations from the age of 3 months, with an increase in the circumference of the right lower limb, visible superficial venous system and purplish coloration, without compromised mobility. […] In adults, popliteal artery aneurysm is the second most common type of peripheral arterial aneurysm after aortoiliac aneurysm. Atherosclerosis is its most common etiology, while less common causes include trauma, congenital popliteal aneurysm, mycotic aneurysm, and inflammatory arteritis. […] Non-traumatic arterial aneurysms in the pediatric population are very rare and usually associated with inflammatory or degenerative conditions. […] Aneurysm formation is also described in cases of trauma or in diseases such as fibromuscular dysplasia, osteochondroma, infection, and vasculitis.

• #25 Aneurysms of the Popliteal Artery | SpringerLink

  https://link.springer.com/book/10.1007/978-3-030-49687-6

  Popliteal aneurysms are still controversial in terms of their pathogenesis, and challenging in terms of their treatment. […] This book offers a detailed overview of the latest advances in our understanding of the disease, and highlights the latest theories. […] The last section focuses on non-atherosclerotic popliteal aneurysms, i.e. on diseases in which popliteal aneurysms may specifically appear, rendering more challenging the diagnosis and the treatment.

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