Arteriographic evidence of pseudoocclusion of the popliteal artery: Don't be fooled

Abstract

Individuals with chronic lower extremity pain or lifestyle limiting claudication often undergo angiography prior to intervention. Occasionally initial angiographic findings are not indicative of a true pathologic process. Described below are two such cases. Both of the patients described had iliofemoral atherosclerotic disease with arteriographic suggestion of popliteal artery occlusion. However, their medical histories, noninvasive vascular studies, and arteriograms were not consistent with chronic popliteal artery occlusion. On subsequent arteriogram with knee flexion, the occlusions were found to be positional or pseudooccluded. Pseudoocclusion of the popliteal artery (POPA) does not require intervention, and therefore it is necessary to differentiate it from other pathologic processes. Discrimination of POPA from atherosclerotic occlusion, popliteal artery entrapment syndrome, cystic adventitial disease, and vasculitis is possible through history and exam. Arteriography is helpful because a lack of contralateral disease or collateral circulation may indicate a positional occlusion.