Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 12-11: Peripheral Artery Aneurysms + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Widened, prominent pulses Acute leg or foot pain and paresthesias with loss of distal pulses High association of popliteal aneurysms with abdominal aortic aneurysms +++ General Considerations ++ Peripheral artery aneurysms are silent until critically symptomatic (like aortic aneurysms) Presenting manifestations are due to peripheral embolization and thrombosis (unlike aortic aneurysms) Popliteal aneurysms Account for 70% of peripheral arterial aneurysms May embolize repetitively over time and occlude distal arteries Ischemia does not occur until a final embolus occludes flow because of the redundant parallel arterial supply to the foot Primary femoral artery aneurysms Much less common However, pseudoaneurysms of the femoral artery following arterial punctures for arteriography and cardiac catheterization occur with an incidence ranging from 0.05% to 6% + Clinical Findings Download Section PDF Listen +++ ++ Popliteal aneurysms Often undetected by patient and clinician Patient may be aware of a pulsatile mass when the aneurysm is in the groin Peripheral aneurysms May produce symptoms by compressing the local vein or nerve (rarely) First symptom may be due to ischemia of acute arterial occlusion Symptoms range from sudden-onset pain and paralysis to short-distance claudication that slowly lessens as collateral circulation develops Symptoms from recurrent embolization to the leg are often transient Sudden ischemia may appear in a toe or part of the foot, followed by slow resolution Onset of recurrent episodes of pain in the foot, particularly if accompanied by cyanosis, suggests embolization and requires investigation of the heart and proximal arterial tree + Diagnosis Download Section PDF Listen +++ ++ Palpation of a pulsatile aneurysm in the contralateral popliteal space may aid in diagnosis of thrombosis of popliteal aneurysms Ultrasonography For patients in whom there is a prominent or easily felt pulse (popliteal pulses are usually somewhat difficult to palpate in normal individuals) Abdominal ultrasonography for patients with popliteal aneurysms to determine whether an abdominal aortic aneurysm is also present Duplex color ultrasound is the most efficient to Confirm the diagnosis of peripheral aneurysm Measure its size and configuration Demonstrate mural thrombus Magnetic resonance angiography or computed tomographic angiography is required to define the aneurysm and local arterial anatomy for reconstruction Arteriography is not recommended because mural thrombus reduces the apparent diameter of the lumen on angiography + Treatment Download Section PDF Listen +++ ++ Surgery indications To prevent limb loss from thrombosis or embolization An aneurysm is associated with any peripheral embolization Aneurysm is > 2 cm Mural thrombus is present Acute ischemia caused by acute embolization or thrombus Bypass is generally performed Endovascular exclusion of the aneurysm can be done but is reserved for high-risk patients Intra-arterial thrombolysis may be done in the setting of acute ischemia, if examination (light touch) remains intact, suggesting that immediate surgery is not imperative Acute pseudoaneurysms of the femoral artery due to arterial punctures can be successfully treated using ultrasound-guided compression Open surgery with prosthetic interposition grafting is preferred for primary aneurysms of the femoral artery + Outcome Download Section PDF Listen +++ +++ Prognosis ++ If left untreated, approximately one-third of patients will require an amputation Long-term patency of bypass grafts for femoral and popliteal aneurysms is generally excellent, but depends on the adequacy of the outflow tract Late graft occlusion is less common than in similar surgeries for occlusive disease Approximately 50% of patients with popliteal aneurysms have an aneurysmal abdominal aorta +++ When to Refer ++ Patient has symptoms of ischemia Patient has a peripheral arterial aneurysm measuring 2 cm or has ultrasound evidence of thrombus within the aneurysm + Reference Download Section PDF Listen +++ + +Leake AE et al. Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 2017 Jan;65(1):246–56. [PubMed: 28010863]