Popliteal Artery Diseases

Popliteal Entrapment

• • Rare cause of stenosis or occlusion

  • Occurs because of anomalous course of popliteal artery

  • Popliteal artery passes medial to medial head of gastrocnemius muscle (normally passes lateral)

  • -Causes compression of popliteal artery when knee extended

  • 5 anatomic variations

  • Fibrous thickening progresses to occlusion, with poststenotic dilation which may be source for mural embolus

Cystic Degeneration of Popliteal Artery

• • Arterial stenosis produced by mucoid cyst in adventitia

  • Located in middle third of artery

Epidemiology

Popliteal Entrapment

• • Occurs more often in young, healthy persons

Symptoms and Signs

Popliteal Entrapment

• • Symptoms range from calf claudication to severe ischemia

  • Diminished pedal pulses with foot dorsiflexion and plantar flexion

  • Atherosclerotic changes absent

Cystic Degeneration of Popliteal Artery

• • Calf claudication most common

  • Decreased pedal pulse strength

  • Mass may be palpated (rarely)

Imaging Findings

Popliteal Artery Entrapment

• • MRI often useful to diagnose

Cystic Degeneration of Popliteal Artery

• • Arteriography: Sharply localized zone of politeal stenosis with smooth concentric tapering, having hourglass appearance

  • US/CT scan: Can demonstrate cyst in artery wall

• • Atherosclerotic changes absent

• • Complete history and physical exam

  • -Consider diagnosis in young healthy patient with calf claudication or ischemia

Surgery

Popliteal Entrapment

• • Division of medial head of gastrocnemius muscle, graft replacement of diseased artery; lumbar sympathectomy performed as well

Cystic Degeneration of Popliteal Artery

• • Cyst excision, may recur

  • Arterial excision and graft replacement may be necessary in some patients

References