Popliteal Artery Thrombosis Research Articles

SEVERE EVOLUTION WITH MULTIPLE SEPTIC DETERMINATIONS IN A PATIENT DIAGNOSED WITH STREPTOCOCCUS GALLOLYTICUS INFECTION

Streptococcus gallolyticus, member of streptococcus bovis group colonizes digestive tubes of birds, cows and human (2.5-15%). Literature describes the association between bacteriemia with Streptococcus gallolyticus and colon tumours but also extracolonic lesions (bacterial endocarditis, vertebral osteomyelitis, dyscitis, colangitis, lung tumors, ovarian tumors). We report the case of a 60 years old male caucasian patient who was diagnosed with vertebral osteomyelitis as the first lesion of Streptococcus gallolyticus infection identified by blood culture. Other lesions were diagnosed on aortic valve (bacterian endocarditis), right popliteal artery (popliteal artery thrombosis), right knee (arthritis). Even if there was a clinical and biological improvement during the treatment, the imaging tests done after 30 and 45 days from the diagnosis showed severe aortic insuficiency so surgical intervention for aortic valvuloplasty was done in a short time. Vertebral and popliteal artery lesions have improved within two months of antibiotic treatment. Colonoscopy, which was done 6 weeks from the diagnosis showed colonic polyps – risk factors of Streptococcus gallolyticus bacteriemia. This case proves that Streptococcus gallolyticus infection has a silent period followed by severe evolution by multiple septic lesions inspite of the precocious treatment and warn of the necessity of digestive investigations at these patients.

Popliteal Artery Thrombosis After Open Reduction and Internal Fixation of the Patella: A Case Report.

A 31-year-old man presented with a right patellar fracture after a motor-vehicle accident. He had a history of a myocardial infarction and cerebrovascular accident, for which he reported taking aspirin and clopidogrel daily. One hour after surgery, an acute popliteal artery thrombosis was detected. The patient was ultimately successfully managed with endovascular placement of a catheter and a 14-hour infusion of tissue plasminogen activator. The patient had no further known thromboembolic events after 11 months of follow-up. High suspicion must be maintained for acute thromboembolic events in patients with a history of such events.

Popliteal artery thrombosis complicating posterior tibial exostosis in a 35-year-old male

Chronic popliteal artery thrombosis complicating tibial exostosis has never been described as far as we know. Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses. The diagnosis was confirmed based on CT angiography showing distinct blockage of the contrast product over an exostosis on the posterior side of the proximal tibia. Treatment consisted of removing the exostosis and then bypassing the popliteal artery with a reversed autogenous venous graft.

Bilateral iliac and popliteal arterial thrombosis in a child with focal segmental glomerulosclerosis.

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%–5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.

Popliteal artery thrombosis caused by osteochondroma: A rare presentation

Popliteal entrapment syndrome should be considered as a cause of lower limb vascular insufficiency in young adults. It is often caused by musculotendinous structures and bony abnormalities are rarely implicated. Early diagnosis and prompt surgical treatment are the key factors for a better prognosis. This report describes a rare case of popliteal artery thrombosis cause by an osteochondroma treated by surgical resection with good results.

Temporary prophylactic intravascular balloon occlusion of the common iliac arteries before cesarean hysterectomy for controlling operative blood loss in abnormal placentation

ObjectivesThe purpose of this study was to investigate the efficacy and safety of temporary prophylactic intravascular balloon occlusion of the common iliac arteries (CIA) before planned cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Materials and methodsA retrospective study of 13 pregnant women at risk for placenta accreta identified using sequential obstetric ultrasonography and magnetic resonance imaging from January 2007 to December 2009 was performed. Temporary prophylactic intravascular balloon catheterization of the bilateral CIA before cesarean hysterectomy was performed by interventional radiologists. The maximum duration of occlusion time of CIA must not exceed 60 minutes. The primary outcome for this study included estimated blood loss and secondary outcomes included the development of thromboembolism, disseminated intravascular coagulation and surgical complications. ResultsAmong these13 patients, the mean age of the patients was 32.8 ± 0.7 years (range 29–37 years). The mean gestational age at cesarean hysterectomy was 32.2 ± 0.9 weeks (range 28–36 weeks), and the mean intraoperative blood loss was 1902.3 ± 578.8 mL (range 500–8000 mL). Operative bleeding was controlled by conservative treatment without additional surgery in two cases. Importantly, two patients (15.8%) had severe complications possibly related to the interventional procedure. One patient was noted to have a popliteal artery thrombosis. A second patient had an external iliac artery thrombosis with 80–90% occlusion. Both patients required antithrombotic treatment without sequelae. ConclusionWith limited experience in this small series, we observed a statistically significant reduction in operative blood loss after the use of temporary prophylactic balloon occlusion of the CIA technique compared with historical controls of similar demographic characteristics previously published (1902.3 ± 578.8 mL, range 500–8000 mL vs. 4445.7 ± 996.48 mL, range 1040–15,000 mL, p = 0.0402). Additionally, two patients had arterial thrombosis. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness and safety of this new technique.

Popliteal Artery Thrombosis after Total Knee Replacement: An Unusual Complication.

Popliteal Artery Thrombosis after Total Knee Replacement: An Unusual Complication.

Varicella pneumonia associated with spontaneous popliteal arterial thrombosis in an adult: a case study and review of the literature

Introduction: Chickenpox is generally a childhood exanthematic benign self‐limited disease. In contrast, most complications and fatal cases occur among adults, which is the group that suffers less commonly from this disease. The frequency of chickenpox in adults is increasing worldwide, together with the associated complications, mainly varicella pneumonia, which can lead to death. The incidence of other complications such as peripheral artery thrombosis is much lower but can cause important morbidity. Case presentation: We report the case of a 63‐year‐old male smoker, who was otherwise previously healthy, who was admitted to the Emergency Department with chickenpox and varicella pneumonia with respiratory insufficiency requiring mechanical ventilation and intensive care unit admission. During hospitalization, the patient developed spontaneous popliteal artery thrombosis that finally led to transfemoral amputation. Conclusions: Varicella pneumonia and peripheral artery thrombosis are two of the known complications of chickenpox. Both complications seem to be much more frequent in men with an active smoking habit. Clinicians should be aware of these complications in order to recognize them promptly and provide adequate treatment.

Ulcerative Colitis and Limb Loss: A Case Report

Introduction: Protein C is a precursor of a vitamin K-dependent serine protease, which is activated by thrombin in the presence of endothelial cofactor, thrombomodulin and endothelial cell protein C receptor. Case Presentation: A 33-year old woman with acute exacerbation of ulcerative colitis was found to have protein C deficiency (serum protein C activity estimated as 35% of the normal activity). Protein C deficiency was diagnosed after the onset of several arterial thromboemboli complications (brachiocephalic and popliteal artery thrombosis) during her hospital admission for exacerbation of ulcerative colitis (UC). Therefore, upper limb below elbow and lower limb below knee amputation were performed for her. Conclusions: After total proctocolectomy, serum protein C activity remained as 35% of the normal activity, so the patient used warfarin as lifelong anticoagulant. Investigation of other family members revealed normal thrombophilia screening tests.

Acute aortoiliac thrombotic occlusion in an infant with protein C deficiency and small atrial sepal defect—A rare case

Aortoiliac thrombosis is rare in infants and neonates. Protein C deficiency is frequently observed with venous thromboembolism, but off-late report of arterial thrombosis is increasingly common. We report a case of large infrarenal aortoiliac saddle and right popliteal artery thrombosis in a 7-month-old infant, with 3-mm atrial septal defect without clinical and Doppler evidence of deep vein thrombosis, presented with acute bilateral lower limb ischemic attack. Diagnosis was made by computed tomographic (C T) angiography of aorta and bilateral lower limbs. Patient operated on in emergency by transperitoneal route. Aortoiliac and right popliteal artery thromboembolectomy with closure of aortotomy with polytetraflouroethylene patch was performed.

Small Incision Fasciotomy in a Patient with Compartment Syndrome and Peripheral Arterial Occlusive Disease

An 82-year-old-man with a previous history of atrial fibrillation was admitted with acute limb ischemia. Emergent embolectomy was performed, but after the operation, the patient suffered from recurrent ischemic pain. Peripheral angiography revealed thrombosis of the distal popliteal artery due to pre-existing peripheral arterial occlusive disease. Bypass surgery of the popliteal artery and posterior tibial artery was then performed. Although peripheral blood flow was restored after the operation, he suffered from compartment syndrome the next day. The patient was treated with an emergent bed-side fasciotomy using a small incision, achieving full recovery of blood flow to the distal artery. The wound closed secondarily without surgical closure. In a patient with peripheral arterial occlusive disease, fasciotomy should be performed at a lower compartment pressure due to a lack of peripheral perfusion pressure. Emergent small incision fasciotomy was effective in this patient with an acute compartment syndrome and an ischemic limb.

Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment.

Popliteal artery thrombosis secondary to a tibial osteochondroma

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

Popliteal artery thrombosis following total knee arthroplasty: A preventable complication with surveillance

Popliteal artery thrombosis following total knee arthroplasty: A preventable complication with surveillance

Successful Retrial of ECT Two Months After ECT-Induced Takotsubo Cardiomyopathy

heart failure; however, recovery of cardiac function is often complete within the first week following the insult. Cardiac enzymes may be mildly elevated, but on cardiac catheterization there is usually no evidence of coronary artery disease, or only "mild luminal irregularities" may be noted (7). Contraction band necrosis may be seen on biopsy in the more serious cases. The cause of takotsubo cardiomyopathy is unknown, but several mechanisms have been suggested, including ischemia from coronary artery spasm, microvascular spasm, and direct myocyte injury (5).

Outcome after knee dislocation

Knee dislocations are limb-threatening injuries and, if not treated appropriately, may result in significant functional disability. Currently, there is a paucity of high-quality outcome studies in the literature to help guide optimal treatment strategies for these complex injuries [2]. Highlevel studies are extremely difficult to achieve because of the heterogeneity of the study population and the wide variation in injury patterns. Assessing outcomes is equally difficult as a large number of knee dislocation patients sustain polytrauma and may have other ipsilateral and contralateral limb injuries. The literature to date has focused primarily on case series and surgical technique, with very few papers comparing treatment strategies or reporting on outcomes. Even the definition of a knee dislocation, in terms of the number of ligaments ruptured, remains contested. Many authors suggest that a minimum of three ligaments must be disrupted, while others contend that two ruptured ligaments (the PCL-intact knee dislocation) still constitute a dislocated knee. Wide variations in the definition of ‘‘acute’’ reconstruction are also noted, and no standardized functional scoring system has been universally reported. All of these factors make interpretation of the available literature extremely difficult. Several controversies persist regarding treatment of the dislocated knee. Surgical timing, graft selection, repair versus reconstruction of the medial and lateral structures, surgical techniques, and postoperative rehabilitation remain topics of debate. We recently performed a systematic review of the literature and found evidence to support early [\3 weeks] operative intervention of all damaged ligamentous structures compared to nonoperative or delayed intervention. We also found a higher rate of revision for repair as opposed to reconstruction for the fibular collateral ligament (FCL) and posterolateral corner (PLC) [2]. In their prospective level II study [1], the authors found worse outcomes with high-energy compared to low-energy injured knees, and four ligaments compared to two or three ligament-injured knees. No change in outcomes was observed between patients that did or did not sustain neurovascular injury. In addition, they found no difference with acute (\2 weeks) compared to chronic ([2 weeks) surgical intervention. A high level of osteoarthritis (87%) was also found in their series, consistent with previous reports [6]. Surgical techniques and postoperative rehabilitation protocols continue to evolve. A steep learning curve was evident in our own practice with regard to repair and/or reconstruction methods, and over time, we have become less aggressive with early range of motion. In this series, the authors went through similar changes with postoperative rehabilitation and employed numerous surgical techniques for repair and/or reconstruction, in particular for medialand lateral-sided injuries. This indicates the lack of standardization for surgical techniques and the need for better evidence. One of, if not the most important points to highlight is the issue of vascular assessment. We are aware of cases in which an unrecognized complete popliteal artery thrombosis occurred after a knee dislocation. At the time of presentation, radiographs were unremarkable, and the patients had a palpable dorsalis pedis pulse. No further B. A. Levy (&) Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA e-mail: Levy.Bruce@mayo.edu

Acute Arterial Thrombosis After Bilateral Total Knee Arthroplasty

Arterial thrombosis is a rare complication of total knee arthroplasty (TKA). The overall incidence of arterial complications after TKA, including arterial occlusion, arteriovenous fistula, arterial aneurysm, and arterial severance, varies between 0.03% and 0.17% in reports published in the orthopedic literature ( J Vasc Surg 1994;20:927-932). We report a case of acute popliteal artery thrombosis and its sequelae immediately following bilateral TKA performed sequentially under the same anesthesia. This is the first reported case of a post-TKA popliteal artery thrombosis in a patient younger than 60 years without the commonly accepted risk factors.

Mycoplasma pneumoniae Associated with Hemolytic Anemia, Cold Agglutinins, and Recurrent Arterial Thrombosis

A 40-year-old white male developed Mycoplasma pneumoniae pneumonia (IgM titer 1:256) as well as autoimmune hemolytic anemia due to cold agglutinins (titer of 1:512). Four days after admission to the hospital, he developed an acute superior mesenteric artery (SMA) thrombosis. Four feet of ischemic small bowel were resected. A follow-up angiogram again showed SMA thrombosis and a left popliteal artery thrombosis. The patient was returned to the operating room and underwent thrombectomy of the affected arteries. The following day, he again developed a left popliteal artery thrombosis requiring thrombectomy. Plasmapheresis, Coumadin and prednisone were implemented. No further thrombotic events occurred. Hypercoagulability workup was negative. Pathology samples revealed vasculitis. Based on a negative hypercoagulability workup, nonrecurrence of thrombotic events after treatment, and in the absence of any structural abnormalities of the affected arteries, an autoimmune phenomenon with damage to the endothelium was thought to have played a role in the mechanism of thrombosis.

Thrombolysis of Venous and Arterial Thrombosis by Catheter-Directed Low-Dose Infusion of Tissue Plasminogen Activator in Children

Thrombolytic therapy is a well-defined treatment option for arterial and venous thrombosis in adults. In contrast, uniform recommendations regarding the indication, route of administration, and dosing of thrombolytic therapy in children are not available. The authors report the successful resolution of bilateral pulmonary embolism and popliteal artery thrombosis in an 11-year-old girl and 13-year-old girl, respectively, by catheter-directed thrombolysis with low-dose recombinant tissue plasminogen activator. Catheter-directed low-dose thrombolysis is an efficient treatment option for severe venous and arterial thrombosis in children.

Hematocrit-Driven Referrals for Measurement of RBC Mass. Is the Natural History of Polycythemia Vera Changing?.

Red blood cell mass (RCM) elevation is the sine qua non for diagnosis of polycythemia vera (pvera). The Polycythemia Vera Study Group (PVSG) employed therapeutic phlebotomy to lower the HCT to <55% as initial therapy. In the current era of frequent blood testing, RCM is usually requested based only on a high HCT often <55%. Thus the natural history of pvera may be changing if it is being diagnosed at an earlier stage. We reviewed 101 consecutive patients referred in 2002–2003 for RCM testing to characterize RCM requests from a large community referral base. There were 61 men and 40 women with mean HCT<55% (Table 1). 20 had lung disease or were smokers, 3 presented with arterial or venous thrombosis, 7 had cancer, 2 had renal cysts. HCT of men was higher than HCT of women if RCM was normal, but HCT were equivalent between genders if RCM was elevated. HCT was higher in men (p=0.0010) and women (p<0.0001) if RCM was elevated versus normal. HCT elevation was similar in secondary polycythemia vs pvera in men (51.0±4.02 vs 54.3±6.23; p=0.3397) or women (50.5±4.80 vs 49.3±2.12; p=0.4762).Table 1HCT of patients referred for RCM measurementGenderWhole GroupNormal RCMHigh RCMnHCTnHCTnHCTMale6148.3 (47.8) ±4.894546.9 (47.2) ±4.01652.1 (51.3) ±5.16Female4045.0 (43.8)± 4.723243.3 (42.5) ±3.691050.0 (50.0) ±3.84p value0.0001<0.00010.4932HCT shown as Mean (Median) ±SDWe examined whether, despite a lower presenting HCT, those with normal RCM demonstrated PVSG criteria that justified referral to our Nuclear Medicine department. Only 7 of the 75 patients with normal RCM met at least 2 of the PVSG “B” criteria or had splenomegaly, thus might have been diagnosed with pvera had RCM been high (Table 2).Table 22 PVSG “B” criteria or splenomegaly and normal RCMGenderWBC ≥12KPLT ≥400KB12 ≥900≥ LAP 100SplenomegalyM14.4413640158“normal”M12.1585133653“normal”M9.4428113968“normal”M8.6132134315 cmM8.231249218617 cmF18.258271923“normal”F6.3226318“enlarged”F7.114681315.3 cmOverall, 10 of 40 women and 16 of 61 men had an elevated RCM: 4 women and 5 men with polycythemia vera; 6 women and 11 men with secondary polycythemia. One other man was diagnosed with polycythemia vera on the basis of a borderline elevated RCM (33.8 ml/kg), normal O2 Sat on room air, popliteal artery thrombosis, and 3 “B” criteria. Serum erythropoietin (EPO) was low at 2.6 mU/ml (ref range 4–16). He was receiving therapeutic phlebotomy for hereditary hemochromatosis when his RCM was measured. He was the only patient with pvera whose EPO was low (three others had normal EPO levels). The 11 patients with secondary polycythemia who had EPO measured had normal levels. In summary, the HCT was the primary criterion for RCM testing for 2/3 of these patients. Only 5 presented with HCT>55%; mean HCT was ~50% in patients with elevated RCM. The bottom quartile HCT of women with elevated RCM in our patient population was 48.7%. This is a sensitive “cut-off” for finding an elevated RCM (p<0.0001, Chi square with Yates correction). We conclude that patients are referred for RCM testing when a high HCT is found, but at HCT far below the original PVSG parameters. Therefore polycythemia vera is now diagnosed earlier and in mostly asymptomatic patients. A normal EPO level does not rule out a diagnosis of pvera. A HCT < 48.7% may not warrant the measurement of RBC mass.