Open Mitral Valve Reconstruction

Problems in Diagnosis of Popliteal Aneurysms

“…Thirty-one percent of patients in this series developed distal ischaemia presenting as intermittent claudication and 15% of aneurysms had thrombosed. Although distal embolization is a recognized complication which may occur in at least 25% of patients (Gifford et al 1953, Wychulis et al 1970, the differentiation between distal embolization and atherosclerotic occlusion of the tibial and peroneal arteries is difficult in retrospect and was not attempted in this series. Irrespective of the aetiology, however, occlusion of these arteries probably precedes thrombosis of an aneurysm, an event which poses the most serious threat to limb viability: thrombosis of 9 aneurysms resulted in 6 amputations, despite attempted vascular reconstruction in 3 cases.…”

“…They occur almost exclusively in men with generalized atherosclerosis, many of whom have aneurysmal disease of other major arteries (Linton 1949, Gifford et al 1953, Wychulis et al 1970. 'Sinister harbingers of sudden catastrophe' (Gifford et al 1953) aptly describes their propensity to develop thromboembolic complications resulting in a critically ischaemic leg or amputation.…”

“…Evans & Turnipseed (1976) reported that 22 out of 29 (76%) patients treated with a Dacron graft were asymptomatic at the time of review compared with 97% of saphenous vein grafts; the amputation rate was 17% and 3% in each group respectively. Further support for a policy of early operation has come from studies showing, first, that complications may arise irrespective of the size of an aneurysm (Inahara & Toledo 1978) and, second, that a successful outcome of vascular reconstruction is more likely when an aneurysm is asymptomatic than when it is complicated by thromboembolism (Wychulis et al 1970, Reilly et al 1983. Unlike aortic aneurysms, rupture of a popliteal aneurysm is rare and occurred in only 6% of cases.…”

“…Palpation of the normal popliteal artery is difficult and the finding of a prominent pulsation in the popliteal fossa may lead to self-congratulation rather than hospital referral to exclude an aneurysm. Acute ischaemia following thrombosis may be attributed to irremediable atherosclerotic occlusion of the popliteal artery and, although compression of the popliteal vein by an aneurysm may occasionally result in venous thrombosis (Gifford et al 1953, Wychulis et al 1970, this may be the sole diagnosis while the aneurysm remains unsuspected. Patients may complain of symptoms in the calf and foot in the absence of distal ischaemia and it is particularly interesting that 9 patients in this series complained of calf pain at rest or abnormal sensations in the feet.…”

“…Not surprisingly, reconstructive vascular procedures are more often successful when performed for asymptomatic or uncomplicated aneurysms (Wychulis et al 1970, Reilly et al 1983) and it behoves the clinician to make an early diagnosis and referral for treatment. We report here a retrospective analysis of the presentation of 62 popliteal aneurysms and the problems encountered in their diagnosis.…”