Popliteal artery aneurysms are defined as a diameter of 2 cm or ≥1.5 times the normal caliber. Historically, they were described as “sinister harbinger of sudden catastrophe” as they almost certainly lead to acute limb-threatening ischemia. The first successful repair of a popliteal artery aneurysm occurred around 1912 by Dr. Eric Lexer when he utilized a reversed vein graft to bypass the damaged portion of popliteal artery.
Etiology
- Atherosclerotic degeneration
- Marfan syndrome
- Behçet disease
- Mycotic degeneration
- Risk factors: trauma, infection, true aneurysmal degeneration, smoking, hypertension, diabetes mellitus
Epidemiology
- Male predominance
- Age 60-70
Presentation
- Lower extremity ischemia or intermittent claudication (most common) – thrombus or embolization
- Asymptomatic pulsatile mass
- Symptoms
- Limb ischemia
- Rest pain
- Gangrene
- Posterior knee mass
- Local pain
- Leg swelling
- Rupture
Workup
- Duplex ultrasound
- CTA/MRA
Treatment
- Asymptomatic popliteal artery aneurysm <2.0 cm → duplex ultrasound every 6 months
- Symptomatic popliteal artery aneurysm or popliteal artery aneurysm >2.0 cm → repair
- Thrombosed popliteal artery aneurysm → infusion of catheter-directed thrombolysis or open surgical embolectomy and revascularization
- Repair approach
- Open surgery
- Endovascular with covered stents
Relevant Information
- Popliteal artery exits opening in adductor magnus distally and enters popliteal fossa
- Travels lateral to intercondylar fossa of femur and then courses behind knee between two heads of the gastrocnemius and popliteal muscle
- Divides to become tibial arteries at the lower border of popliteus muscle
- Popliteal artery measurements
- Normal diameter → 0.5-0.7 cm (females), 0.5-1.1 cm (males)
- Aneurysm is defined as artery diameter is 2 cm or 1.5 times normal caliber
Resources
- Clinical Guidelines on Popliteal Artery Aneurysms (Society for Vascular Surgeons, 2022)