Impact of Duplex Arteriography in the Evaluation of Acute Lower Limb Ischemia from Thrombosed Popliteal Aneurysms

Abstract

Acute limb-threatening ischemia from thrombosis may be the initial presentation of popliteal artery aneurysms (PAA) and is associated with amputation rates of 20-30%. Since contrast angiography may miss the diagnosis, the authors suspect that thrombosis of PAA may be an underappreciated cause of acute ischemia. Routine use of duplex arteriography (DA) may aid in the diagnosis and may help identify the outflow vessels with improved results. One hundred and nine patients (group 1) from 1994 to 1997 and 201 patients from 1998 to 2001 (group 2) presenting with acute limb-threatening ischemia were studied. None of the group 1 patients underwent preoperative DA and no diagnosis of acute popliteal artery aneurysm thrombosis was made. Ten patients with acute ischemia due to thrombosed popliteal artery aneurysms were identified in group 2 when preoperative DA was routinely performed. Urgent revascularization based on the results from DA was performed with use of autogenous saphenous vein in all patients. Six patients had functioning bypasses with a mean follow-up of 15.6 months. There were 3 deaths, 2 within 30 days and 1 after 2(1/2) years with functioning grafts. One patient was lost to follow-up. No major amputations were performed. Incidence of thrombosed popliteal artery aneurysms as the cause of acute limb-threatening ischemia is probably underestimated. Routine use of DA may provide the diagnosis and identifies the available outflow vessels. Contrary to previously published reports, urgent revascularization of an acutely ischemic extremity from thrombosed popliteal aneurysm can provide excellent rates of limb salvage.

Popliteaaneurysmaassoziierte Probleme

“…Zudem können im Rahmen der Gefäßdar-stellung durch die zeitgleiche Abbildung der umliegenden Gewebestrukturen Begleiterkrankungen als mögliche Kontraindikation für ein Thrombolyseverfahren detektiert werden. » Beim PAA ermöglicht die Duplexsonographie eine schnelle und sichere Diagnose Im Notfallgeschehen und bei Kontraindikationen hinsichtlich einer Gabe jodierter Kontrastmittel lässt auch die Nativ-CT in Kombination mit der vorliegenden Symptomatik, der ABIMessung und dem erhobenen Duplexsonographiebefund [12] das Erstellen eines therapeutischen Konzepts mit dem Ziel der sofortigen Umsetzung zu. …”

Lower-limb vascular imaging with acoustic radiation force elastography: Demonstration of in vivo feasibility

“…The ABI computes the ratio of dorsalis pedis and posterior tibial arterial systolic pressures to the brachial systolic pressure; ABI values below 0.9 show high sensitivity and specificity for detection of occlusions greater than 50% in major peripheral vessels, with values below 0.4 correlating with increased vascular obstruction and severe ischemia [15]. Duplex ultrasound, magnetic resonance angiography (MRA), X-ray angiography, and cardiac MR provide excellent measurements of luminal diameter, identification of stenosis in the lower extremities [16], [17], and, in the case of cardiovascular MR imaging and duplex ultrasound, additional information regarding plaque composition. Most current clinical approaches to the evaluation of the lower-limb vasculature, however, remain limited to identification of stenosis and luminal reduction, rather than plaque characterization.…”