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Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Aneurysms, Peripheral. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49661988. Accessed June 29, 2017. MLA Citation . "Aneurysms, Peripheral." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49661988. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Aneurysms, Peripheral + Essential Features Print Section + • True aneurysms: Involves all 3 layers of vessel wall• False aneurysm (pseudoaneurysm): Disruption of artery causing contained hematoma confined by fibrous capsule ++ Lower Extremity + • 70% of peripheral aneurysms are of popliteal artery; femoral artery next most common site• Persistence of sciatic artery -Rare anomaly-Large embryonic sciatic artery (originates from internal iliac artery) communicates directly with popliteal artery;-Propensity for aneurismal degeneration ++ Upper Extremity + • Subclavian artery aneurysms: Rare-Several causes: Pseudoaneurysms from drug addict injections increasing, poststenotic dilation from patient with cervical rib or thoracic outlet syndrome, congenital variant with aberrant artery arising from proximal descending thoracic aorta (Kommerell's diverticulum)• Radial artery pseudoaneurysms: Increased as a result of increased radial artery catheters, occasionally infected ++ Epidemiology + • 0.5-6% incidence of pseudoaneurysm of femoral artery after puncture• Popliteal aneurysms bilateral in 50%• 33% of patients with popliteal aneurysm have AAA + Clinical Findings Print Section ++ Symptoms and Signs + • Usually minimal until progressive thrombosis, stenosis occurs• Femoral: Throbbing mass in groin often present• Popliteal: Usually asymptomatic-First symptom often acute ischemia-Thrombosis, peripheral embolization cause acute ischemia-Occlusion may occur from fragmentation of mural thrombus-Thrombus may occlude lumen of aneurysm or embolize-Can progress rapidly to gangrene-Recurrent embolization presents with sudden ischemia of toe or foot with gradual resolution-Popliteal aneurysms rarely cause symptoms from compression of vein or tibial nerve-Palpation suggests diagnosis• Persistent sciatic artery aneurysms: Painful, pulsatile buttock mass• Subclavian: Emboli to fingers, dysphagia lusoria (difficulty swallowing) ++ Imaging Findings + • US confirms size, diagnosis, flow• Arteriography advised before operation + Diagnostic Considerations Print Section + • Evaluate for multiple sites of aneurysm• Evaluate for distal ischemia or embolus + Work-up Print Section + • US confirms diagnosis• Arteriography may not demonstrate aneurysm but is advised before operative repair to define distal arteries + Treatment and Management Print Section + • Immediate operation or thrombolytic therapy indicated when pregangrenous• Femoral pseudoaneurysm treated with US-guided compression ++ Surgery + • Femoral artery: Replace diseased segment• Popliteal artery: Exclude and bypass with saphenous vein• Sciatic nerve: Exclude aneurysm and bypass with saphenous vein• Subclavian: Resect first rib or cervical rib, divide scalenus anterior, replace aneurysm with graft• Radial pseudoaneurysm -Normal Allen test, excise and ligate -Abnormal Allen test, reconstruct artery ++ Indications + • Pregangreneous ischemia• Recurrent peripheral embolization• Symptomatic aneurysm• Asymptomatic aneurysm 3 × normal diameter ++ Medications + • Thrombolytics for occluded popliteal aneurysms should be considered ++ Prognosis + • Depends on outflow tract• Late graft failures less common than operations done for peripheral vascular occlusive disease + Resources Print Section ++ References ++Diwan A et al. Incidence of femoral and popliteal aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2000;31:863. [PubMed: 10805875] ++Henry M et al. Percutaneous endovascular treatment of peripheral aneurysms. J Cardiovasc Surg. 2000;41:871. [PubMed: 11232970] ++Curi MA et al: Mid-term outcomes of endovascular popliteal artery aneurysm repair. J Vasc Surg 2007;45:505. [PubMed: 17275247] ++Ganchi PA et al: Ruptured pseudoaneurysm complicating an infected radial artery catheter: case report and review of the literature. Ann Plast Surg 2001;46:647. Review. ++Kazmers A et al: Nonoperative therapy for postcatheterization femoral artery pseudoaneurysms. Am Surg 1997;63:199. [PubMed: 9012437] ++Wain RA, Hines G: A contemporary review of popliteal artery aneurysms. Cardiol Rev 2007;15:102. Review.