In embryo, sciatic artery provides blood supply to leg
Normally replaced by primitive femoral artery
Arises from external iliac artery via capillary plexus; joins sciatic artery in knee region
If femoral artery not established as lower extremity inflow, may have persistence of sciatic artery
Internal iliac artery continues as sciatic artery; enters thigh posteriorly via sciatic foramen
Descends in posterior thigh adjacent to sciatic nerve sheath; continues as popliteal artery
Rare abnormality (incidence: 0.025-0.040%)
Bilateral in 25% of cases
2 forms of persistent sciatic artery
Complete form (63-79% of cases)
Superficial femoral artery (SFA) hypoplastic or absent; typically ends in fork-like configuration
Sciatic artery is dominant arterial supply to leg
Incomplete form
Femoral artery & SFA are dominant supply to leg
Small persistent sciatic artery; may or may not communicate with popliteal artery
Clinical manifestations
Usually presents as aneurysm (25-58%)
Thrombosis, distal embolization, mass effect
May present as tender pulsatile buttock mass
Absent femoral pulse; palpable popliteal pulse
Very susceptible to atherosclerotic disease
Pertinent Infrainguinal Vascular Anatomy
Common femoral artery (CFA): Continuation of external iliac artery below inguinal ligament
Inguinal ligament corresponds to inferior epigastric/deep circumflex iliac artery origins
Bifurcates 2 cm below inguinal ligament into superficial & deep femoral arteries
SFA: Extends from femoral bifurcation to adductor hiatus
Courses in adductor (Hunter) canal
Canal extends from femoral triangle to adductor hiatus (opening in adductor magnus muscle)
Deep (profunda) femoral artery: Extends from femoral bifurcation into thigh musculature
Provides important collaterals; perforating branches resistant to atherosclerosis
Popliteal artery
SFA becomes popliteal artery at adductor hiatus
Courses behind knee, between gastrocnemius heads
Bifurcates into anterior tibial, tibioperoneal trunk
Anterior tibial artery
Passes anteriorly through intraosseous membrane
Becomes dorsalis pedis artery at ankle level
Tibioperoneal trunk
Divides into peroneal & PT arteries
Peroneal artery
Lies in deep posterior compartment; medial to fibula
May reconstitute dorsalis pedis artery
PT artery
Supplies posterior compartment of calf
Distally forms plantar arch of foot
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Leake AE et al: Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 65(1):246-256.e2, 2017
Motaganahalli RL et al: A multi-institutional experience in adventitial cystic disease. J Vasc Surg. 65(1):157-161, 2017
Warhadpande S et al: Popliteal artery cystic adventitial disease: early lessons in treatment. Ann Vasc Surg. 38:255-259, 2017
Giaquinta A et al: Endovascular treatment of chronic occluded popliteal artery aneurysm. Vasc Endovascular Surg. 50(1):16-20, 2016
Raherinantenaina F et al: Management of extremity arterial pseudoaneurysms associated with osteochondromas. Vascular. 24(6):628-637, 2016
von Stumm M et al: Two decades of endovascular repair of popliteal artery aneurysm--a meta-analysis. Eur J Vasc Endovasc Surg. 50(3):351-9, 2015
Kovacs F et al: Endovascular stent graft repair of iatrogenic popliteal artery injuries--a report of 2 cases. Vasc Endovascular Surg. 46(3):269-72, 2012
Pulli R et al: Comparison of early and midterm results of open and endovascular treatment of popliteal artery aneurysms. Ann Vasc Surg. 26(6):809-18, 2012
Kawai N et al: Bilateral profunda femoris artery and left common femoral artery aneurysms presenting as lower limb ischemia. Ann Vasc Surg. 25(5):700, 2011
Yamamoto H et al: Intermediate and long-term outcomes after treating symptomatic persistent sciatic artery using different techniques. Ann Vasc Surg. 25(6):837, 2011
Bellosta R et al: Fate of popliteal artery aneurysms after exclusion and bypass. Ann Vasc Surg. 24(7):885-9, 2010
Etezadi V et al: Endovascular treatment of popliteal artery aneurysms: a single-center experience. J Vasc Interv Radiol. 21(6):817-23, 2010
Jung E et al: Long-term outcome of endovascular popliteal artery aneurysm repair. Ann Vasc Surg. 24(7):871-5, 2010
Kurc E et al: Traumatic aneurysm in persistent sciatic artery. Innovations (Phila). 5(2):131-3, 2010
Callcut RA et al: Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury. J Trauma. 67(2):252-7; discussion 257-8, 2009
Tielliu IF et al: Treatment of popliteal artery aneurysms with the Hemobahn stent-graft. J Endovasc Ther. 10(1):111-6, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
Arterial laceration: Complete or incomplete arterial transection
Most often due to penetrating or iatrogenic trauma
Popliteal artery particularly susceptible to trauma from posterior knee dislocation
May result in arterial laceration, intimal disruption
May lead to thrombosis, pseudoaneurysm
Clinical manifestations
Pulsatile bleeding or expanding hematoma
Absent distal pulses with cold, pale limb
Palpable thrill or audible bruit
Various imaging manifestations
Active contrast extravasation
May be due to partial arterial disruption or complete arterial transection
Complete occlusion of artery with absent runoff
Formation of traumatic arteriovenous fistula
Pseudoaneurysm formation
Cystic adventitial disease (CAD): Nonatherosclerotic disease characterized by compression of arterial lumen by subadventitial gelatinous cysts
Uncommon disease; mainly affects young males
M:F = 15:1
Exact pathogenesis poorly understood & controversial; various etiologic theories
Traumatic adventitial degeneration
Remnant mesenchymal rests during development
Cysts arise from synovium
Affects popliteal artery in 85-90% of cases
Also reported in common femoral, external iliac, axillary, brachial, ulnar, & radial arteries
Can also rarely affect venous structures
Clinical manifestations
Usually presents with sudden onset of claudication
May worsen with flexion of knee
Pseudoaneurysm (false aneurysm): Disruption of arterial wall with resultant contained rupture
May occur secondary to blunt or penetrating trauma
May also result in arterial laceration/transection
May be iatrogenic
Most commonly results from percutaneous arterial access; typically involves CFA
May be secondary to postoperative disruption of vascular surgical anastomosis
May rarely occur in association with skeletal osteochondromas
Popliteal artery most commonly affected
Major morbidity if unrecognized/untreated
Potential for pseudoaneurysm rupture
Distal thromboembolism with ischemia
Popliteal artery aneurysm (PAA): Abnormal arterial enlargement of ≥ 50% of normal vessel diameter
Most common aneurysm of native peripheral arteries
M:F ratio = 15:1
60-70% bilateral
If bilateral PAAs present, 75% also have abdominal aortic aneurysm
Degenerative etiology > 90%
Other well-recognized causes
Behçet disease
Ehlers-Danlos syndrome
Marfan syndrome
Mycotic aneurysms
Trauma
Clinical manifestations
When symptomatic, usually presents with limb ischemia from aneurysm thrombosis/distal emboli
Emergent intervention often necessary
Pulsatile mass in popliteal fossa
Popliteal deep vein thrombosis (DVT) or posterior tibial (PT) neuropathy may sometimes occur
Caused by compression of adjacent vein &/or nerve by aneurysm
In embryo, sciatic artery provides blood supply to leg
Normally replaced by primitive femoral artery
Arises from external iliac artery via capillary plexus; joins sciatic artery in knee region
If femoral artery not established as lower extremity inflow, may have persistence of sciatic artery
Internal iliac artery continues as sciatic artery; enters thigh posteriorly via sciatic foramen
Descends in posterior thigh adjacent to sciatic nerve sheath; continues as popliteal artery
Rare abnormality (incidence: 0.025-0.040%)
Bilateral in 25% of cases
2 forms of persistent sciatic artery
Complete form (63-79% of cases)
Superficial femoral artery (SFA) hypoplastic or absent; typically ends in fork-like configuration
Sciatic artery is dominant arterial supply to leg
Incomplete form
Femoral artery & SFA are dominant supply to leg
Small persistent sciatic artery; may or may not communicate with popliteal artery
Clinical manifestations
Usually presents as aneurysm (25-58%)
Thrombosis, distal embolization, mass effect
May present as tender pulsatile buttock mass
Absent femoral pulse; palpable popliteal pulse
Very susceptible to atherosclerotic disease
Pertinent Infrainguinal Vascular Anatomy
Common femoral artery (CFA): Continuation of external iliac artery below inguinal ligament
Inguinal ligament corresponds to inferior epigastric/deep circumflex iliac artery origins
Bifurcates 2 cm below inguinal ligament into superficial & deep femoral arteries
SFA: Extends from femoral bifurcation to adductor hiatus
Courses in adductor (Hunter) canal
Canal extends from femoral triangle to adductor hiatus (opening in adductor magnus muscle)
Deep (profunda) femoral artery: Extends from femoral bifurcation into thigh musculature
Provides important collaterals; perforating branches resistant to atherosclerosis
Popliteal artery
SFA becomes popliteal artery at adductor hiatus
Courses behind knee, between gastrocnemius heads
Bifurcates into anterior tibial, tibioperoneal trunk
Anterior tibial artery
Passes anteriorly through intraosseous membrane
Becomes dorsalis pedis artery at ankle level
Tibioperoneal trunk
Divides into peroneal & PT arteries
Peroneal artery
Lies in deep posterior compartment; medial to fibula
May reconstitute dorsalis pedis artery
PT artery
Supplies posterior compartment of calf
Distally forms plantar arch of foot
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Leake AE et al: Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 65(1):246-256.e2, 2017
Motaganahalli RL et al: A multi-institutional experience in adventitial cystic disease. J Vasc Surg. 65(1):157-161, 2017
Warhadpande S et al: Popliteal artery cystic adventitial disease: early lessons in treatment. Ann Vasc Surg. 38:255-259, 2017
Giaquinta A et al: Endovascular treatment of chronic occluded popliteal artery aneurysm. Vasc Endovascular Surg. 50(1):16-20, 2016
Raherinantenaina F et al: Management of extremity arterial pseudoaneurysms associated with osteochondromas. Vascular. 24(6):628-637, 2016
von Stumm M et al: Two decades of endovascular repair of popliteal artery aneurysm--a meta-analysis. Eur J Vasc Endovasc Surg. 50(3):351-9, 2015
Kovacs F et al: Endovascular stent graft repair of iatrogenic popliteal artery injuries--a report of 2 cases. Vasc Endovascular Surg. 46(3):269-72, 2012
Pulli R et al: Comparison of early and midterm results of open and endovascular treatment of popliteal artery aneurysms. Ann Vasc Surg. 26(6):809-18, 2012
Kawai N et al: Bilateral profunda femoris artery and left common femoral artery aneurysms presenting as lower limb ischemia. Ann Vasc Surg. 25(5):700, 2011
Yamamoto H et al: Intermediate and long-term outcomes after treating symptomatic persistent sciatic artery using different techniques. Ann Vasc Surg. 25(6):837, 2011
Bellosta R et al: Fate of popliteal artery aneurysms after exclusion and bypass. Ann Vasc Surg. 24(7):885-9, 2010
Etezadi V et al: Endovascular treatment of popliteal artery aneurysms: a single-center experience. J Vasc Interv Radiol. 21(6):817-23, 2010
Jung E et al: Long-term outcome of endovascular popliteal artery aneurysm repair. Ann Vasc Surg. 24(7):871-5, 2010
Kurc E et al: Traumatic aneurysm in persistent sciatic artery. Innovations (Phila). 5(2):131-3, 2010
Callcut RA et al: Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury. J Trauma. 67(2):252-7; discussion 257-8, 2009
Tielliu IF et al: Treatment of popliteal artery aneurysms with the Hemobahn stent-graft. J Endovasc Ther. 10(1):111-6, 2003
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