What is popliteal artery aneurysm?

A popliteal artery aneurysm is the name for a vascular abnormality that occurs in the popliteal artery, located in the area behind the knee joint. It is a bulging or a protrusion in the weakened arterial wall.

There are several causes for a popliteal artery aneurysm, including:

• Atherosclerosis.
• High blood pressure.
• Weakening due to natural wear and tear of the popliteal artery.
• A weakened arterial wall.

Although popliteal artery aneurysms are not common, they have a higher incidence in men who also have an abdominal aortic aneurysm.

Among the potential risks for developing this condition, we can highlight:

• Being an older adult.
• High blood pressure.
• Smoking.
• Stenotic disease.
• Having other aneurysms in any other body area.

A popliteal artery aneurysm can develop silently, without presenting any symptoms for a long time. But if symptoms do appear, the most common signs usually include persistent or intermittent pain in the back of the knee or calf, as well as a pulsating sensation or a mass in that area.

Some patients may also experience weakness or numbness in the affected leg, which can make it difficult to walk normally.

In more advanced cases, symptoms can intensify if the aneurysm compresses nearby nerves or veins. This can cause swelling, changes in skin color, coldness in the foot, or ulcers on the toes.

Thrombosis is one of the most serious complications of a popliteal artery aneurysm. It can lead to acute leg ischemia, compromising its blood supply and causing intense pain, loss of sensation, or paralysis.

There is also a risk of embolization, where small clots break off and block more distal arteries, causing tissue damage, but this is less frequent than in other types of aneurysms.

The diagnosis begins with a clinical evaluation, where the doctor may detect a pulsating mass behind the knee through a physical examination. However, since many cases are asymptomatic, they are often discovered incidentally during studies for other causes or in patients with a history of aneurysms in other arteries, such as the abdominal aorta.

Imaging tests are essential for a confirmatory diagnosis. Doppler ultrasound is often the initial tool used most frequently, as it allows doctors to visualize blood flow and measure the size of the aneurysm.

For more complex cases or for surgical planning, studies like computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) can be performed, which provide more precise anatomical details.

Treatment will be chosen based on the size of the aneurysm, symptoms, and the risk of complications. If the aneurysm is small and asymptomatic, conservative management may be used, with recurrent monitoring to track its growth.

Medications to prevent clot formation, such as anticoagulants, may also be prescribed, especially if there is turbulent blood flow within the aneurysm.

If the aneurysm reaches a critical size, causes symptoms, or poses a risk of thrombosis, surgical treatment is usually recommended. There are two main options:

• Open surgery: A bypass is performed using a graft to redirect blood flow.
• Endovascular repair: This involves inserting a covered stent to isolate the aneurysm.

The choice of one method over the other will depend on the patient’s anatomical characteristics and the vascular surgeon’s judgment.

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