Occlusion Of Popliteal Artery Research Articles

Relationship between the angle of popliteal artery trifurcation branches and atherosclerosis burden in chronic peripheral arterial disease

Aim: The aim of this study was to investigate the relationship between the angles of the popliteal artery trifurcation branches and atherosclerosis burden in patients with peripheral arterial disease (PAD). Material-Methods: Digital subtraction angiography (DSA) images of patients who underwent angioplasty for lower extremity PAD between April 2021 and 2023 were retrospectively analysed. The study excluded non-type 1a popliteal artery branching variations, critical stenosis or occlusion cases, and those with motion artifacts or previous femoropopliteal bypass operations. Angles of the anterior tibial artery (ATA), posterior tibial artery (PTA), and fibular artery (FA) were measured. Atherosclerosis burden was scored from 0 to 18 based on luminal narrowing and occlusion in each artery. Spearman correlation analysis was used to examine the relationship between trifurcation angles and atherosclerosis burden. Results: A total of 68 patients were included, with a mean age of 65 years. Angioplasty was performed on the right side in 56% of patients and on the left side in 44%. The ATA angle showed a weak positive correlation with atherosclerosis burden (rs = 0.144, p = 0.29). In contrast, PTA and FA angles exhibited moderate (rs = 0.398, p = 0.001) and strong (rs = 0.599, p < 0.001) positive correlations, respectively. Conclusion: This study highlights the significant association between the angulation of popliteal artery trifurcations and atherosclerosis burden, suggesting that vessel geometry should be considered in the management of PAD.

An old but still valuable technique for popliteal artery stenosis: Endarterectomy via the posterior approach.

Isolated popliteal artery occlusions are rare compared with femoropopliteal occlusive diseases. Although endovascular procedures have gained importance in treatment, conventional surgery remains the gold standard. In this study, we reviewed popliteal endarterectomy and patch plasty using a posterior approach. Fourteen patients who underwent surgery for isolated popliteal artery occlusions were retrospectively examined. Patients were assessed in terms of age, sex, and risk factors, such as accompanying diseases and smoking, surgical method and anesthesia, incision type, preoperative and postoperative pulse examination, ankle-brachial indices, patency, wound infection, postoperative complications, and the treatment applied. Twelve (85.7%) patients were male, and 2 (14.3%) were female. Limb ischemia was critical (ABI < 0.7) in 11 (78.5%) patients. The average duration of postoperative hospitalization was 8 ± 3.7 days on average, and the average length of follow-up was 17 ± 3.4 months. Thrombosis and complications requiring secondary intervention did not develop during the early postoperative period. While the patency rate in the first 6 months of follow-up was 100%, it was 92.8% in the 1st year and 85.7% in the 2nd year. Surgical treatment with the posterior approach in isolated popliteal artery lesions is preferred by vascular surgeons as a prioritized treatment method, with a sufficient recanalization rate and low perioperative morbidity and mortality rates. Furthermore, it is promising because it does not prevent below-knee femoropopliteal bypass, which is the subsequent stage of treatment. Moreover, the great saphenous vein was protected, and the acceptable early- and mid-term results were encouraging.

Safety and effectiveness of the Phoenix atherectomy device for endovascular treatment of common femoral and popliteal arteries: Results of the EN-MOBILE trial.

Background: This study aimed to assess the peri- and postprocedural outcomes of atherectomy-assisted endovascular treatment of the common femoral (CFA) and popliteal arteries. Methods: Phoenix atherectomy was used for the treatment of 73 and 53 de novo CFA and popliteal artery lesions, respectively, in 122 consecutive patients. Safety endpoints encompassed perforation and peripheral embolization. Postprocedural endpoints included freedom from clinically driven target lesion revascularization (CD-TLR) and clinical success (an improvement of ⩾ 2 Rutherford category [RC]). In addition, 531 patients treated for popliteal artery stenosis or occlusion without atherectomy were used as a comparator group. Results: Procedural success (residual stenosis < 30% after treatment) was 99.2%. The need for bail-out stenting was 2 (2.7%) and 3 (5.7%) in CFA and popliteal artery lesions, respectively. Only one (1.4%) embolization occurred in the CFA, which was treated by catheter aspiration. No perforations occurred. After 1.50 (IQR = 1.17-2.20) years, CD-TLR occurred in seven (9.2%) and six (14.6%) patients with CFA and popliteal artery lesions, respectively, whereas clinical success was achieved in 62 (91.2%) and 31 (75.6%), respectively. Patients treated with atherectomy and DCB in the popliteal artery after matching for baseline RC, lesion calcification, length, and the presence of chronic total occlusion, exhibited higher freedom from CD-TLR compared to the nondebulking group (HR = 3.1; 95% CI = 1.1-8.5, p = 0.03). Conclusion: Atherectomy can be used safely and is associated with low rates of bail-out stenting in CFA and popliteal arteries. CD-TLR and clinical success rates are clinically acceptable. In addition, for the popliteal artery, atherectomy combined with DCB demonstrates lower CD-TLR rates compared to a DCB alone strategy. (German Clinical Trials Register: DRKS00016708).

Association between clinical and sonographic patterns of major peripheral arterial occlusion among patients presenting with lower limb dry gangrene at a single center in Western Uganda

Abstract Background Dry gangrene occurs due to a reduced blood supply in body parts, resulting in gradual necrosis. It is among the leading indications for lower limb amputation; however, in situations where timely access of accurate diagnostic and revascularization services are limited, irrational amputations are performed based on mere physical assessment of a specific occluded major arterial segment, consequently preceded with gangrene recurrence on the same limb stump due to physical examination inaccuracies. Objectives We assessed the lower limb dry gangrene patterns and analyzed arterial Doppler reports of these cases to determine the associations between dry gangrene patterns and specific occluded major lower limb arteries to elevate the degree of accuracy of physical assessments. Methods In this cross-sectional study, 36 patients with lower limb dry gangrene were consecutively enrolled. Dry gangrene patterns and Doppler ultrasound reports of the major arteries of the affected lower limbs were assessed. Data were entered in EPIDATA and exported to STATA version 15 for cleaning and analysis. Clinical and sonographic characteristics are summarized as median and frequencies. Odds ratios (ORs) were tabulated and reported relating the dry gangrene patterns and major arterial occlusion levels as a measure of associations; P value &lt; 0.05 were considered statistically significant. Results Dry gangrenes demarcated on the toes (61.1%), toes–distal foot 27.8%, and toes–proximal foot and leg (11.1%). Doppler ultrasound revealed femoral arteries (38.9%), popliteal (66.7%), and infra-popliteal (88.9%–100%) arterial occlusions. Association between dry gangrenes demarcating toes–proximal foot and leg with femoral arterial occlusions (ORs: 6.2 and 3.2, respectively), whereas dry gangrene demarcating toes and toes–distal foot with popliteal arterial occlusions (OR, 1.6; P value, 0.05). Conclusion Dry gangrene demarcating the toes–proximal foot and leg has a significant association with femoral arterial occlusions, whereas demarcation at the toes and toes–distal foot are more associated with popliteal arterial occlusions.

Sapheno Femoral Graft End-to-End Anastomose due to Total Occlusion of Left Popliteal Artery: A Case Report and Literature Review

Background: For patients suffering from trauma around the knee joint, the clinician should be highly vigilant about the risk of popliteal artery acute thrombosis. It is essential to promptly detect and treat acute popliteal artery thrombosis for limb salvaging. Further diagnostic procedures may be performed according to the patient’s hemodynamics. Doppler should be considered done bedside, while CTA should be considered if the obstruction could not be concluded by physical examination. Case: A 40-year-old male complained of a bluish left leg, difficulty in movement, and decreased sensation. Computed tomography angiography (CTA) evaluation revealed total occlusion of the left popliteal artery. An open wound that was managed improperly was referred to a vascular surgeon in the central hospital to be further treated. The patient was hospitalized for 3 days for anastomosis monitoring and discharged uneventfully. Conclusion: Sapheno Femoral Graft End-to-End Anastomose is an effective therapeutic option in patients with total occlusion popliteal artery.

Delayed Presentation of Popliteal Artery Injury after Salter-Harris III Proximal Tibia Fracture

Introduction. Proximal tibia physeal fractures in children are not very common but can be dangerous because they can harm popliteal fossa structures, especially the popliteal artery. Popliteal artery injuries (PAI) are most commonly the result of trauma to the lower extremity, including blunt force, hyperextension injuries, complex fractures, and knee dislocations that can compromise popliteal neurovascular structures. Case Presentation. A 14-year-old boy presents to the emergency department after being transferred from an outside hospital 24 hours after a left lower extremity hyperextension injury. Radiographs demonstrated a Salter-Harris III proximal tibia fracture with posterior displacement. ABIs were deferred due to palpable distal pulses and no evidence of compartment syndrome. Closed reduction and percutaneous pinning were planned to correct the fracture. Intraoperatively, it was discovered that knee extension decreased lower extremity perfusion while knee flexion returned perfusion. An angiography revealed a popliteal artery occlusion with no distal flow. Based on this, an above-knee to below-knee popliteal bypass using the contralateral great saphenous vein was performed followed by closed reduction and percutaneous pinning of the proximal tibia. Conclusion. Proximal tibia physeal injuries, especially the Salter-Harris III and IV injuries, warrant a high index of suspicion of popliteal artery injuries. Palpable pulses and delayed presentation in the distal lower extremity do not rule out a PAI because collateral flow to the anterior and posterior tibial arteries may mask signs of an avascular limb, highlighting the need for a thorough history and physical exam. The authors present this case to reaffirm the importance of an ankle-brachial index when evaluating hyperextension injuries with proximal tibial epiphyseal fractures.

Delayed Diagnosis of Ischemia after Popliteal Artery Injury during total Knee Arthroplasty

Over 600,000 TKA are performed annually in the USA. Injuries to the popliteal artery are unusual, estimated to occur in less than 0.2% of cases [1-3]. Three mechanisms of injury have been reported, the use of a pneumatic tourniquet in patients with advanced atherosclerosis [4], sharp, direct trauma to the vessels and stretching or kinking of the artery when the knee is manipulated [5,6]. It is generally believed that popliteal artery occlusion rapidly causes acute ischemia after popliteal artery occlusion because of the paucity of collaterals. Cases of acute ischemia after TKA that slowly evolve and that have been diagnosed and treated on a delayed basis have been rarely reported [3]. This may be because delays in diagnosis frequently result in major morbidity and litigation.

1001 A Case Report on Popliteal Artery Occlusion After a Low-Energy Trauma Years After Total Knee Arthroplasty

Abstract Aim To highlight the significance of dislocated total knee arthroplasty, which is more likely to happen after a low-energy trauma and can result in limb-threatening neurovascular complications and compartment syndrome, we present a case of mild trauma that resulted in the co-occurrence of the occlusion of the left popliteal artery and vein 10 years after the implantation. Method Three weeks after a low-energy fall on her knee at home, a 69-year-old woman presented to our orthopedics clinic with swelling, paresthesia, and paralysis in her left leg. She had edema and significant ecchymosis, and the tibial pulses in her left knee had vanished. She had uneventful bilateral knee arthroplasty surgery on her right and left knees six and ten years ago, respectively. Her medical history is significant for type 2 diabetes mellitus and hypertension. Doppler ultrasound and CT angiography showed occluded popliteal artery and vein. Following thromboembolectomy by cardiovascular surgeons, orthopedic surgeons underwent lower leg preventative fasciotomy under general anesthesia by creating two longitudinal incisions on either side of the tibia. Results Doppler ultrasonography on the fifth follow-up day revealed biphasic flow in the posterior tibial artery and monophasic flow in the dorsal tibial artery, however, the paralysis and paresthesia were still present. Ultimately, unilateral above-knee amputation was performed. Conclusions Due to the high level of concern for vascular injury and compartment syndrome, we advise physicians to consider popliteal artery injury while treating patients who underwent total knee arthroplasty years ago and present with minimal trauma.

Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome

Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. This is a retrospective review of patients referred for PAES at a single institution. We reviewed non-invasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software (PACS). Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak-systolic velocity (PSV) of 78 cm/sec at rest. With forced plantar flexion, the PSV increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n=35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (p=0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm) while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should therefore be the gold standard for the diagnosis of PAES.

Skeletal muscle oxidative adaptations following localized heat therapy

Repeated heat treatment has been shown to induce oxidative adaptations in cell cultures and rodents, but similar work within human models is scarce. This study investigated the effects of 6 weeks of localized heat therapy on near-infrared spectroscopy-(NIRS) derived indices of muscle oxidative and microvascular function. Twelve physically active participants (8 males and 4 females, age: 34.9 ± 5.9 years, stature: 175 ± 7 cm, body mass: 76.7 ± 13.3 kg) undertook a 6-week intervention, where adhesive heat pads were applied for 8 h/day, 5 days/week, on one calf of each participant, while the contralateral leg acted as control. Prior to and following the intervention, the microvascular function was assessed using NIRS-based methods, where 5 min of popliteal artery occlusion was applied, and the reperfusion (i.e., re-saturation rate, re-saturation amplitude, and hyperemic response) was monitored for 2 min upon release. Participants also performed a 1-min isometric contraction of the plantar flexors (30% maximal voluntary contraction), following which a further 2 min interval was undertaken for the assessment of recovery kinetics. A 20-min time interval was allowed before the assessment protocol was repeated on the contralateral leg. Repeated localized heating of the gastrocnemius did not influence any of the NIRS-derive indices of microvascular or oxidative function (p > 0.05) following 6 weeks of treatment. Our findings indicate that localized heating via the use of adhesive heat pads may not be a potent stimulus for muscle adaptations in physically active humans.

Traumatic Popliteal Artery Occlusion Following Lower Extremity Crush Injury Presenting With Isolated Patellar Dislocation.

While traumatic popliteal artery injury historically has a low incidence, failure to acutely recognize the vascular insult poses a significant risk of limb loss and functional impairment. A 71-year-old male presented with left lower extremity pain in setting of a crush injury working underneath a vehicle resulting in an isolated lateral dislocation of his patella and complete occlusion of the distal popliteal artery. He was taken to the operating room for an in-situ bypass and four-compartment fasciotomy. His hospital stay included three staged washouts/debridements with eventual closure. He was discharged after 38days to a rehabilitation facility with ability to self-ambulate with assistance within one month. This patient's presentation is unique for his isolated patellar dislocation without associated injuries characteristically associated with a traumatic vascular injury of the popliteal artery and serves to remind the importance of complete examination in the setting of blunt trauma.

Lung cancer embolization causing acute limb ischemia: a case report

BackgroundAcute tumour embolism to the popliteal artery resulting in limb-threatening ischemia is a rare complication of neoplastic disease. Generally, tumors embolize to the pulmonary circulation via the venous system. In this case, the originating tumor was a lung cancer of a large size and advanced stage that had invaded the left atrium of the heart and disseminated in the systemic circulation. The tumor likely fragmented, resulting in showering to the right popliteal artery, superior mesenteric artery, and left renal artery, which is a unique presentation of tumor embolism.Case reportWe present a case of a 62-year-old Caucasian gentleman with a large left lower lobe squamous cell lung cancer that had invaded into the left atrium via the pulmonary veins. He presented with acute limb threatening ischemia. A computed tomographic angiogram revealed an occlusion of the left popliteal artery as well as embolization to the superior mesenteric artery and the right renal artery. He was started on intravenous heparin and underwent an emergency popliteal embolectomy and calf fasciotomies, which was limb saving. His fasciotomy wounds were closed after 1 week and he was discharged on anticoagulation.ConclusionThis is a rare case of tumor embolism resulting in both an embolectomy and calf fasciotomies. In the light of such cases, we suggest that tumors invading the bloodstream should be considered high risk for embolization and hypothesize that prophylactic antithrombotic therapy may avoid major morbidity.

Meta-Analysis on Clinical Outcomes of Paclitaxel-Coated Balloon Angioplasty in Femoral Popliteal Artery Occlusion

Meta-Analysis on Clinical Outcomes of Paclitaxel-Coated Balloon Angioplasty in Femoral Popliteal Artery Occlusion

Comparative study between surgical arterial bypass and endovascular interventions in the treatment of popliteal artery occlusion

Comparative study between surgical arterial bypass and endovascular interventions in the treatment of popliteal artery occlusion

Adolesanda Diz Çıkığı Nedeniyle Yavaş İlerleyen Popliteal Arter Oklüzyonu Sonrası Flep Nekrozu: Bir Olgu Sunumu

Abstract&#x0D; Popliteal artery occlusion is a rare vascular complication after blunt knee trauma and may lead to limb loss if diagnosis is delayed. Development of collateral pathways may misguide the surgeon in planning surgeries for defect reconstruction. We report a case of a patient with popliteal artery occlusion resulting from dislocation of knee after fall from height, which developed a defect anteromedial to ankle following orthopedic surgery. After reconstruction with a free flap, ischemia was observed in foot and arteriography confirmed the occlusion of popliteal artery with well-developed collateral arteries. The patient underwent femoro-popliteal bypass surgery for limb salvation. At the end of the recovery time, the defect was reconstructed with cross leg free flap

Abstract 15051: A Large Mitral Valve Vegetation in a Patient Presented With Low Back Pain and Lower Limb Weakness- A Success Story of a Multidisciplinary Team

Case presentation: A 58-year-old gentleman presented to A&amp;E with low back pain for a few days and lower limb weakness for 24 hours. His background history was not medically significant. On examination, GCS 14/15, lower limbs power 2/5, and palpable urinary bladder. DRE revealed poor anal tone. MRI spine showed epidural abscess at L3-L4 &amp; L5-S1 level and urgent decompressive spinal surgery was performed. IV antibiotics were started and the patient was admitted to the general HDU for vasopressor support. Since the operation, he developed cold, pale, swollen right leg, with no palpable peripheral arteries. A CT aortogram showed occlusion of the right popliteal artery. Right popliteal artery exploration with anterior and posterior tibial embolectomy and fasciotomies were done. As the patient was slow to wake up post-surgery, he was transferred to ICU. MRI brain showed no pathology. Transthoracic echocardiogram revealed no vegetation. As clinical suspicion of infective endocarditis was high, transoesophageal echocardiogram and real-time 3D analysis was done which showed a large highly mobile echogenic mass attached to the left atrial surface of the anterior mitral leaflet (A1 and A2) causing moderate MR. Urgent surgical mitral valve repair and removal of a 2 cm vegetation were performed. Both the blood culture and the culture of the vegetation tissue confirmed the growth of Staphylococcus aureus (MSSA). After 8 weeks of hospital stay, the patient was discharged home. Discussion: The objective of this case presentation is to reemphasize that infective endocarditis is not a single organ disease and can present to different specialities. Transthoracic echocardiography has reduced sensitivity in the critical care setting. So, there should be a relatively low threshold for transoesophageal echocardiography. Although the mortality rate of infective endocarditis is relatively high in ICU patients, multidisciplinary team management may result in favourable outcomes.

Endovascular treatment of Buerger's disease in patients with critical limb ischaemia.

Thromboangitis obliteransis (TAO) is a nonatherosclerotic, inflammatory, occlusive arteritis that affects small and medium-sized arteries, veins and nerves. A large proportion of patients with TAO suffer from claudication, and the ultimate condition is gangrene and limb loss if there is no treatment or the cessation of smoking. Endovascular revascularisations are performed frequently and provide acceptable results in patients who are not suitable for surgery. In this study, we aimed to show our clinical experience in patients with TAO who were treated with endovascular revascularisation. Between January 2014 and March 2020, 18 patients with lower-extremity critical limb ischaemia (CLI) underwent endovascular treatment (ET). Technical details and clinical success at follow up were documented. This study included 18 patients with lower-extremity TAO who presented with CLI and were treated with ET. The mean age of the patients was 38.8 ± 7.3 years. Fifty per cent of patients had pain at rest, 33.7% had minor tissue loss and non-healing ulcers, and 16.7% had major tissue loss on admission. The majority of lesions were located in the peroneal and tibial arteries (n = 13, 72.27percnt;). Two (11.1%) patients had distal superficial femoral artery occlusion concomitant with popliteal artery (PA) lesions, and three (16.7%) had PA occlusion concomitant with peroneal and tibial artery lesions. Re-establishment of antegrade flow in at least one vessel was achieved in 15 (83.3%) patients. Balloon angioplasty was performed in all patients. Plain old balloon angioplasty (POBA) was used in nine (60%) patients and drug-eluting balloon (DEB) angioplasty in six (40%). The mean duration of follow up in 15 patient who had undergone successful ET was 21.5 ± 8.1 months. The primary CLI-free rate at 12 and 24 months was 80% (66.7% in all patients). Secondary CLI-free rates at six, 12 and 24 months were 100, 93.3 and 53.3%, respectively. Patients who were active smokers during their follow up had a higher frequency of out-patient clinic consultations (p = 0.03). Controversy has continued on the role of ET in the treatment of TAO. This study shows that ET of TAO had promising primary and secondary patency rates with high technical success and limb-salvage rates.

Isolated Spontaneous Popliteal Artery Dissection

A 61 year old man presented with acute right popliteal artery occlusion three times in 50 days due to an untreated, underlying dissection. Complete flow restoration and symptom relief were achieved three times by local thrombolysis. Initial ultrasonography, computed tomography angiography, and arteriography from different angles failed to unmask the underlying lesion. (A) Magnetic resonance angiogram after thrombolysis revealed an intimal flap (black arrow), suggesting an isolated spontaneous popliteal artery dissection with complete false lumen thrombosis. (B) Optical coherence tomography noted an intimal tear (white arrow). A covered self expandable stent (Viabahn; Gore, Flagstaff, AZ, USA) was deployed to cover the entire dissection.Image 1

Outcomes of Popliteal Endarterectomy and Infrapopliteal Angioplasty for Short Atherosclerotic Popliteal Artery Occlusion: Single-Center Case Series

Localized popliteal artery occlusion (LPAO) is a rare entity with a challenging therapy. In selected patients, open popliteal endarterectomy (OPE) with infrapopliteal balloon angioplasty (IPA) can be limb-saving. The aim of this retrospective study from Iraq-Kurdistan is to assess the procedure outcomes. Over 5years, ending at 2020, 28 patients with atherosclerotic LPAO unsuitable for femoropopliteal bypass or endovascular intervention received OPE+IPA through a medial approach under spinal anesthesia. Perioperative data were obtained from patients' records and entered into an Access database. Results were retrieved and statistically analyzed. There were 18 (64.3%) males. The mean age was 66.4±6.53years (range 52-79 years). Seventy five percent of patients had obesity, diabetes mellitus, and smoking. Twenty six (92.9%) of patients were in Rutherford category 5 and 6 with an ankle-brachial index < 0.40. Popliteal and pedal pulses were absent in 23 of 24 (95.8%) patients. Doppler ultrasound showed a good distal runoff in 1 (3.6%) patient. Computed tomography angiography revealed 20 (71.4%) femoropopliteal and 16 (57.1%) infrapopliteal lesions of types A and B as per Trans-Atlantic Inter-Society Consensus II document. Mean endarterectomy length was 5.1cm (range 3-7), patched with a vein in (17, 60.7%) and primarily closed in (11, 39.3%) patients. Early complications were none in (18, 64.3%) patients whereas 1 leg was amputated on day 30. On average, follow-up lasted 3.4years. Twenty seven (96.4%) vessels remained patent and 2 (7.1%) patients died. Our study confirms safety and efficacy of OPE+IPA for selected patients with critical limb ischemia due to LPAO.

Bilateral popliteal artery occlusion in a young woman as a rare complication of systemic sclerosis: A case report

Systemic sclerosis (SSc) is an autoimmune rheumatic disorder characterized by vascular damage, sclerotic skin changes, and multi-system involvement of internal organs. Digital ischemic lesions, nailfold capillary abnormalities, and secondary Raynaud’s phenomenon are common manifestations of microvascular injuries. Recent findings have revealed that macrovascular involvement in SSc more prevalent than previously believed. There have been reports of large vessel involvement, such as the ulnar, femoral, carotid, renal, and pulmonary arteries. We report here a case of a young woman with progressive SSc who complained of lower limb pain, dysphagia secondary to esophageal dysfunction, and urinary incontinence.She had symptoms of Raynaud’s phenomenon, skin sclerosis, sclerodactyly, digital pitting ulcers,nailfoldcapillary abnormalities, and digital ischemia. On special examination, the anti-centromere antibody was detected. She developed bilateral popliteal artery occlusion as a complication of SSc.