The retrospective analysis showed that in the follow-up 2 (3,6 %) primarily repaired popliteal aneurysms had a recurrence with an increase in size. They were both repaired via a medial approach. In both cases the recirculation was diagnosed via the geniculate vessels. According to the endoleak classification of endovascularly repaired aortic aneurysms, the diagnosis is equivalent to an endoleak type  II classification. [nl]The ligation alone, without the occlusion of the geniculate branches, lead to a persistent back flow and reperfusion with increase in size of the aneurysms. The therapeutic option of such recurrences, due to the presence of active genicular recirculation ought to be the occlusion of these vessels that supply the aneurysm. The safest method to prevent such recurrences is without doubt the extirpation, the aneurysmo-endorraphy as well as the proximal and distal ligation, that definitely occludes the genicular vessels. As a rule the duplex sonography examination is advisable to control repaired popliteal aneurysms in situ.

Peripheral vascular injuries are the cause of high morbidity in trauma patients. Up to 5 % of all patients with injuries of the extremities present with concomitant vascular lesions. While open peripheral vascular injuries are associated with a high mortality at the scene of the accident, closed vascular injuries present the danger of developing critical tissue ischemia with a high risk of amputation and limb loss. Early diagnosis is crucial in order to rapidly restore and maintain adequate blood flow and downstream tissue perfusion. A correct diagnosis and early treatment of peripheral vascular injuries place enormous demands on interdisciplinary teams consisting of emergency physicians, orthopedic surgeons, vascular surgeons, anesthesiologists and radiologists. The top priority in the context of emergency care is hemorrhage control by applying direct pressure and dressings until definitive surgical treatment. Hypovolemic shock, reperfusion injury and compartment syndrome are complications of peripheral vascular injuries that must be recognized and treated in the early stages.

Die zystische Adventitiadegeneration ist eine seltene, nicht-atheromatöse Gefäß-erkrankung, die mit einer atypisch, wechselnden Claudicatio intermittens einhergeht und eine periphere arterielle Verschlusskrankheit vortäuschen kann [1]. Die Erstbeschreibung geht auf Atkins und Key 1947 zurück, die diese vaskuläre Lä-sion am Iliakalstromgebiet eines 40-jähri-gen Mannes diagnostizierten [2]. Hirdonn et al. beschrieben 1951 erstmals die erfolgreiche Behandlung [9]. In der Literatur ist die zystische Adventitiadegeneration durch Kasuistiken in Klinik, Diagnostik und Therapieoptionen gut dokumentiert, wenngleich die Genese uneinheitlich und zum Teil kontrovers dargestellt wird. Derzeit sind weltweit bis 400 Fälle publiziert [4, 5]. Mit Abstand am häufigsten ist die A. poplitea betroffen. Bei geringer Inzidenz, in einer Häufung von 1 : 1 200 Fällen, dominiert das männliche Geschlecht (über 80 % aller Fälle) und wird gehäuft im 4. und 5. Dezennium diagnostiziert. Differenzialindikatorisch sind ein vorliegendes Entrapment-Syndrom, die fibromuskuläre Dysplasie sowie externe Kompression durch eine BAKER-Zyste in der Fossa poplitea auszuschließen [6-8].

No abstract

No abstract