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For further information, see CMDT Part 12-11: Peripheral Artery Aneurysms

Key Features

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

  • 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

  • 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

  • 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 ...

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