Aneurysm, Femoral And Popliteal
Femoral and popliteal aneurysms result from progressive atherosclerotic changes occurring in the walls (medial layer) of the major peripheral arteries. Aneurysmal formations may be fusiform (spindle-shaped) or saccular (pouchlike), with fusiform occurring three times more frequently than saccular. They may be single or multiple segmental lesions, often company other arterial aneurysms located in the abdominal aorta or iliac arteries.
This condition occurs most frequently in men over age 50. The clinical course is usually progressive, eventually ending in thrombosis, embolization, and gangrene. Elective surgery before complications arise greatly improves the prognosis.
Femoral and popliteal aneurysms are usually secondary to atherosclerosis. Rarely, they result from congenital weakness in the arterial wall. They may also result from trauma (blunt or penetrating), bacterial infection, or peripheral vascular reconstructive surgery (which causes "suture line" aneurysms, whereby a blood clot forms a second lumen, also called false aneurysms).
Signs and symptoms
Popliteal aneurysms may cause pain in the popliteal space when they're large enough to compress the medial popliteal nerve and edema and venous distention if the vein is compressed. Femoral and popliteal aneurysms can produce symptoms of severe ischemia in the leg or foot, due to acute thrombosis within the aneurysmal sac, embolization of mural thrombus fragments and, rarely, rupture.Symptoms of acute aneurysmal thrombosis include severe pain, loss of pulse and color, coldness in the affected leg or foot, and gangrene. Distal petechial hemorrhages may develop from aneurysmal emboli
In femoral aneurysm, the diagnosis is usually confirmed by bilateral palpation that reveals a pulsating mass above or below the inguinal ligament. When thrombosis has occurred, palpation detects a firm, nonpulsating mass.
Arteriography or ultrasonography may be indicated in doubtful situations. Arteriography may also detect associated aneurysms, especially those in the abdominal aorta and the iliac arteries. Ultrasonography may be helpful in determining the size of the popliteal or femoral aneurysm.
Femoral and popliteal aneurysms require surgical bypass and reconstruction of the artery, usually with an autogenous saphenous vein graft replacement. Arterial occlusion that causes severe ischemia and gangrene may require leg amputation.
Before corrective surgery:
After arterial surgery:
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