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KEY FACTS
Preprocedure
Procedure
TERMINOLOGY
Definitions
- Arterial injury
- Complete or incomplete arterial transection
- Can result in extravasation, truncation, arteriovenous fistula (AVF) or pseudoaneurysm
- Clinical manifestations
- Pulsatile bleeding or expanding hematoma
- Absent distal pulses with cold, pale limb
- Palpable thrill or audible bruit
- Most often due to penetrating trauma
- Popliteal artery particularly susceptible to trauma from posterior knee dislocation
- Can also occur in blunt trauma
- Complete or incomplete arterial transection
- Pseudoaneurysm
- a.k.a. 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
- Iatrogenic
- From percutaneous arterial access
- Postoperative disruption of vascular surgical anastomosis
- Potential for pseudoaneurysm rupture
- Popliteal artery aneurysm (PAA)
- Abnormal arterial enlargement of ≥ 50% of normal vessel diameter
- Typically > 1.5-2.0 cm
- 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%
- Clinical manifestations
- Rare rupture, most often limb ischemia from aneurysm thrombosis/distal emboli
- Pulsatile mass in popliteal fossa
- Popliteal deep vein thrombosis (DVT) or posterior tibial (PT) neuropathy from compression
- Abnormal arterial enlargement of ≥ 50% of normal vessel diameter
- Persistent sciatic artery (PSA)
- Persistence of embryonic lower extremity arterial supply fails to regress
- During development, 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
- During development, replaced by primitive femoral artery
- 2 forms of PSA
- 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 PSA; may or may not communicate with popliteal artery
- Complete form (63-79% of cases)
- Clinical manifestations
- May degenerate to aneurysm, leading to distal embolization, thrombosis
- Cold leg
- Alternatively, may present as tender, pulsatile buttock mass
- May degenerate to aneurysm, leading to distal embolization, thrombosis
- Persistence of embryonic lower extremity arterial supply fails to regress
- Arterial injury
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
- Continuation of external iliac artery below inguinal ligament
- 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)
- Courses in adductor (Hunter) canal
- Extends from femoral bifurcation to adductor hiatus
- Profunda femoris 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
- Supplies posterior compartment of calf
- Common femoral artery (CFA)
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
- Ning J et al: Outcomes of popliteal stent-graft placement at the artery hinge point for popliteal artery aneurysm. Ann Vasc Surg. ePub, 2022
- Khurana A et al: Endovascular interventions in the management of acute extremity trauma: a narrative review. Ann Transl Med. 9(14):1197, 2021
- le Roux A et al: Yield of CT angiography in penetrating lower extremity trauma. Emerg Radiol. 28(4):743-9, 2021
- Schechtman DW et al: Utility of the mangled extremity severity score in predicting amputation in military lower extremity arterial injury. Ann Vasc Surg. 70:95-100, 2021
- Elliott JE et al: Management of a large ruptured popliteal artery aneurysm involving combined deployment of a covered stent graft and evacuation of popliteal fossa hematoma. J Vasc Surg Cases Innov Tech. 6(1):27-30, 2020
- Marcia L et al: Predictors of peripheral vascular injury in patients with blunt lower extremity fractures. Ann Vasc Surg. 57:35-40, 2019
- Leake AE et al: Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 65(1):246-56.e2, 2017
- Motaganahalli RL et al: A multi-institutional experience in adventitial cystic disease. J Vasc Surg. 65(1):157-61, 2017
- Warhadpande S et al: Popliteal artery cystic adventitial disease: early lessons in treatment. Ann Vasc Surg. 38:255-9, 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):628-37, 2016
- Shahin Y et al: Endovascular versus open repair of asymptomatic popliteal artery aneurysms: a systematic review and meta-analysis. J Vasc Interv Radiol. 27(5):715-22, 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
- Moore RD et al: Open versus endovascular repair of popliteal artery aneurysms. J Vasc Surg. 51(1):271-6, 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
- Hafez HM et al: Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 33(6):1212-9, 2001
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Preprocedure
Procedure
TERMINOLOGY
Definitions
- Arterial injury
- Complete or incomplete arterial transection
- Can result in extravasation, truncation, arteriovenous fistula (AVF) or pseudoaneurysm
- Clinical manifestations
- Pulsatile bleeding or expanding hematoma
- Absent distal pulses with cold, pale limb
- Palpable thrill or audible bruit
- Most often due to penetrating trauma
- Popliteal artery particularly susceptible to trauma from posterior knee dislocation
- Can also occur in blunt trauma
- Complete or incomplete arterial transection
- Pseudoaneurysm
- a.k.a. 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
- Iatrogenic
- From percutaneous arterial access
- Postoperative disruption of vascular surgical anastomosis
- Potential for pseudoaneurysm rupture
- Popliteal artery aneurysm (PAA)
- Abnormal arterial enlargement of ≥ 50% of normal vessel diameter
- Typically > 1.5-2.0 cm
- 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%
- Clinical manifestations
- Rare rupture, most often limb ischemia from aneurysm thrombosis/distal emboli
- Pulsatile mass in popliteal fossa
- Popliteal deep vein thrombosis (DVT) or posterior tibial (PT) neuropathy from compression
- Abnormal arterial enlargement of ≥ 50% of normal vessel diameter
- Persistent sciatic artery (PSA)
- Persistence of embryonic lower extremity arterial supply fails to regress
- During development, 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
- During development, replaced by primitive femoral artery
- 2 forms of PSA
- 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 PSA; may or may not communicate with popliteal artery
- Complete form (63-79% of cases)
- Clinical manifestations
- May degenerate to aneurysm, leading to distal embolization, thrombosis
- Cold leg
- Alternatively, may present as tender, pulsatile buttock mass
- May degenerate to aneurysm, leading to distal embolization, thrombosis
- Persistence of embryonic lower extremity arterial supply fails to regress
- Arterial injury
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
- Continuation of external iliac artery below inguinal ligament
- 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)
- Courses in adductor (Hunter) canal
- Extends from femoral bifurcation to adductor hiatus
- Profunda femoris 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
- Supplies posterior compartment of calf
- Common femoral artery (CFA)
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
- Ning J et al: Outcomes of popliteal stent-graft placement at the artery hinge point for popliteal artery aneurysm. Ann Vasc Surg. ePub, 2022
- Khurana A et al: Endovascular interventions in the management of acute extremity trauma: a narrative review. Ann Transl Med. 9(14):1197, 2021
- le Roux A et al: Yield of CT angiography in penetrating lower extremity trauma. Emerg Radiol. 28(4):743-9, 2021
- Schechtman DW et al: Utility of the mangled extremity severity score in predicting amputation in military lower extremity arterial injury. Ann Vasc Surg. 70:95-100, 2021
- Elliott JE et al: Management of a large ruptured popliteal artery aneurysm involving combined deployment of a covered stent graft and evacuation of popliteal fossa hematoma. J Vasc Surg Cases Innov Tech. 6(1):27-30, 2020
- Marcia L et al: Predictors of peripheral vascular injury in patients with blunt lower extremity fractures. Ann Vasc Surg. 57:35-40, 2019
- Leake AE et al: Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 65(1):246-56.e2, 2017
- Motaganahalli RL et al: A multi-institutional experience in adventitial cystic disease. J Vasc Surg. 65(1):157-61, 2017
- Warhadpande S et al: Popliteal artery cystic adventitial disease: early lessons in treatment. Ann Vasc Surg. 38:255-9, 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):628-37, 2016
- Shahin Y et al: Endovascular versus open repair of asymptomatic popliteal artery aneurysms: a systematic review and meta-analysis. J Vasc Interv Radiol. 27(5):715-22, 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
- Moore RD et al: Open versus endovascular repair of popliteal artery aneurysms. J Vasc Surg. 51(1):271-6, 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
- Hafez HM et al: Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 33(6):1212-9, 2001
