[Embryology, anatomy and rare pathologies of the popliteal artery: Peculiarities of surgical treatment]. / Émbriologiia, anatomiia i redkie patologii podkolennoi arterii: osobennosti khirurgicheskogo lecheniia.

Knowledge of anatomical variations of the division of the popliteal artery and specific lesions of the arterial segment involved is necessary for the surgeon, traumatologist-orthopaedist, vascular surgeon. The article contains a review of recent literature data on the prevalence of different variants of branching patterns of the arteries of the crus, also providing a detailed discussion of embryological development of the arterial system of the lower extremities, in many ways explaining the appearance of rare pathologies of the popliteal artery, such as for example popliteal artery entrapment syndrome. Particular attention is paid to cystic damage of the popliteal artery, describing currently known theories of the development of this rare pathology, this is accompanied by sharing own experience in surgical treatment of the patients involved. Awareness of anatomical variants and peculiarities of embryonic development contributes to decreasing the possibility of iatrogenic damage of the popliteal artery during orthopaedic operations and to appropriate decision-making as to the method of revascularization.

Digital-image analysis of the angiographic patterns of the popliteal artery in patients with aorto-iliac occlusive disease (Leriche syndrome).

Angiographic patterns of the popliteal artery are of great clinical relevance in vascular surgery below the knee. Using radiological, digital and statistical methods the variants and Luminal diameters of the popliteal artery branching in 46 men and 30 women with Lerich syndrome were studied. Statistical analysis did not reveal any gender or syntopic dimorphisms (P > or = 0.05). In subtype IA (87.5%) the anterior tibial artery and the short type of posterior tibioperoneal trunk were found. In subtype IB (2.63%) an arterial trifurcation was observed. In subtype IC (1.97%) the posterior tibial artery and the short type of anterior tibioperoneal trunk were seen. In two subtypes: IIA-1 (1.32%) and IIA-2 (0.66%) the anterior tibial artery and the long type of posterior tibioperoneal trunk were found. In subtype II B (5.92%) the long type of anterior tibioperoneal trunk and the posterior tibial artery were observed. The symmetry of the left and right poptiteal patterns was seen in two most frequent subtypes: I A (r1 = 0.80) and II B (r2 = 0.83). Either the anterior or posterior tibial artery had a smaller diameter than the coexisting tibioperoneal trunk (P<0.01). In a trifurcation the luminal diameters formed a decreasing sequence of the following arteries: anterior tibial, posterior tibial and peroneal. The angiometric analysis of luminal diameters showed the predominant vessel in each subtype: anterior tibioperoneal trunk (IC, IIB), posterior tibioperoneal trunk (IA, IIA-1, IIA-2) and anterior tibial artery (IB).

The persistence of the sciatic artery.

The persistent sciatic artery (PSA) is a rare anatomical variant where the internal iliac artery and the axial artery of the embryo provide the major supply of the lower limb, the superficial femoral artery being usually poorly developed or absent. We describe an extremely large right PSA in a 79-year-old male cadaver during a medical gross anatomy course, with simultaneous existence of a hypoplastic superficial and deep femoral artery. The PSA, which was a continuation of the anterior division of the right internal iliac artery, entered the buttock through the greater sciatic foramen situated in the gluteal region laterally to the sciatic nerve and in the mid thigh medially to the same nerve, becoming in the popliteal fossa the popliteal artery. Neither the superficial nor the deep femoral artery had communication with the popliteal artery. Because the PSA in our study was the only blood supply to the lower limb, we present the embryologic origins and the clinical anatomy of this artery.

Popliteal artery entrapment syndrome.

Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.

Study of the arterial vascularisation of the medial tibial condyle in the fetus.

Varus deformity of the knee is common in young children who have suffered from fulminating purpura. This study was directed at the anatomic features of the vascularisation of the upper end of the tibia that might account for such deformation. It was based on the dissection of 28 anatomic specimens prepared by injection of Indian ink into the vascular trunk. 16 specimens were diaphanised for better analysis of the intracartilaginous distribution of the vessels. The study showed that the vascularisation of the medial condyle of the tibia is poor and of terminal nature, which may explain the occurrence of ischemic growth disorders following fulminating purpura.

Popliteal artery entrapment syndrome. Anatomic and embryologic bases, diagnostic and therapeutic considerations following a series of 15 cases with a review of the literature.

We report 15 examples of popliteal artery entrapment syndrome observed in 11 patients. The anatomical causes were as follows: in one case, the popliteal artery presented an aberrant course medially to the medial head of the gastrocnemius muscle. In 5 cases, there was a small fibrous band linking the medial head of the gastrocnemius muscle to the lateral condyle and crossing behind the popliteal artery; in 5 cases this anomaly was also found in association with an abnormally high and/or internal insertion of the medial head of gastrocnemius muscle. In the last 4 cases, there was a muscular insertion anomaly associated with muscular hypertrophy causing arterial compression. Arteriography performed in the 11 patients showed evocative signs of the diagnosis in all cases where the artery was patent. Two popliteal arteries were occluded. CT scan and MRI examination of the popliteal fossa enabled us to define the muscular origin of the popliteal compression. All of the patients were operated upon; two received a reversed saphenous bypass and all of the others were treated by liberation of the popliteal artery and/or vein by a posterior approach. Follow-up in all patients at long term showed good prognosis. All of the patients were able to take up their previous physical activities without sequelae. Our review of the literature, which is based on 374 cases of popliteal artery entrapment observed in 280 patients, made it possible to define the frequency of the various anomalies observed, their symptoms and the different therapeutic possibilities. The multiple anatomical classifications as well as the arterial and muscular embryology are also described.

Femoral artery hypoplasia and persistent sciatic artery with blue toe syndrome: a case report, histologic analysis and review of the literature.

When the primitive sciatic artery remains the major artery in the thigh, the superficial femoral artery is usually poorly developed or absent. This abnormal vasculature is ascribed to the persistent embryologic arterial system which can occur unilaterally or bilaterally. Sciatic artery is known to be susceptible to aneurysmal changes. Pulsatile gluteal mass, distal embolization and, lower extremity ischemia in the sitting position are the pathognomonic clinical symptoms. Excision of the sciatic artery combined with femoro-popliteal bypass is the established recommended surgical treatment.

The surgical anatomy of the popliteal artery.

The popliteal artery is a common recipient site for above or below knee bypass grafts. It is also frequently affected by penetrating and blunt trauma involving the lower extremity. Exposure of this artery is, therefore, often required in both emergent and elective vascular procedures. In close proximity to the artery, within the confines of the popliteal fossa, are the tibial nerve, common peroneal nerve, and the popliteal vein. An understanding of the normal anatomy and the important variations in the popliteal bifurcation patterns is essential. In this report, we have combined data from new cadaver dissections with prior anatomical data to describe the anatomy of the popliteal fossa and important vascular anomalies.

Double popliteal artery of congenital origin.

An exceptional unilateral right double popliteal artery was discovered by chance. After a review of the possible causes of embryological developmental abnormalities, the most likely hypothesis is that of persistent sciatic artery.

Persistent sciatic artery: a case report.

Persistence of the embryonic sciatic artery is a rare vascular anomaly with only 52 documented cases, of which only 19 had angiographic studies. We describe a patient with angiographic demonstration of persistence of a left sciatic artery associated with arterial anomalies of the opposite limb. The embryology radiological findings and clinical significance are discussed.

[Ischio-popliteal artery trunk, persistence of the axial artery]. / Tronc artériel ischio-poplité, persistance de l'artère axiale.

The authors studied two cases of persistent axial artery of the lower limb, a classic but exceptional variation (42 cases in the literature). It is well explained by embryology and is a recapitulation of anatomy in the animal series. By the systematic study of the literature, we can isolate four distinct types: Type I: Complete axial artery, normal femoral artery. Type II: Id., but incomplete femoral artery, with two subdivisions: II a: Femoral artery is present but incomplete. II b: Femoral artery is absent. Type III: Axial artery only in the proximal zone. Type IV: Axial artery only in the distal zone. In these two last types, the femoral artery is complete. The I, III and IV types correspond to organogenetic perturbation at the stage 21 of Streeter. The type II implies a more early disturbance, prior to stage 18.

[Extrinsic compression of the popliteal artery (author's transl)]. / Compressions extrinsèques de l'artère poplitée.

Popliteal artery compression may be due to trapping of the artery, a tumor, or a subadventricial cyst. Diagnosis is suggested by the discovery of ischemia in a subject who is often young, this being an unusual finding. It is confirmed by dynamic doppler tests, ultrasonography, and vascular opacification. Eight cases of trapped popliteal, three of osteochondroma, and seven cases due to cysts were observed. Surgical treatment is regularly effective and can prevent complications of embolism and acute thrombosis.

Popliteal entrapment syndrome.

A probable cause of popliteal artery entrapment is proposed. The medial head of the gastrocnemius muscle during its embryological development crosses the popliteal fossa from lateral to medial. It is proposed that the migrating medial head carries the popliteal artery and vein across the fossa and entraps them against the medial condyle of the femur. Dissection of 86 anatomical specimens revealed two cases of unilateral and one case of bilateral entrapment of both popliteal vessels. Two surgical cases of popliteal entrapment are presented. This entrapment syndrome is a remedial cause of claudication and when considered, it is readily diagnosed and surgical correction is effective. Because of distal embolisation and occlusions, early recognition and treatment is desirable. Forty-seven cases from the literature are reviewed as to the entrapment type and the age and sex of the patients.