الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome and cystic adventitial disease.
Atherosclerosis is the leading cause of morbidity and mortality in the United States and is the most common cause of popliteal artery occlusion or stenosis.
Most diabetic people harboring atherosclerotic disease of the lower extremities are asymptomatic; others develop ischemic symptoms. Some patients attribute ambulatory difficulties to old age and are unaware of the existence of a potentially correctible problem. Patients who are symptomatic may present with intermittent claudication, ischemic pain at rest, non healing ulceration of the foot or frank gangrene of the foot.
Duplex ultrasound can be used to examine both the ipsilateral and contralateral popliteal arteries. Duplex ultrasound is more sensitive than physical examination in diagnosing popliteal artery disease. Furthermore, it provides information on the presence of stenosis and velocity of flow, presence of mural thrombus, and patency of outflow arteries. Computed tomographic arteriography and magnetic resonance arteriography are useful adjuncts because they provide information on outflow and inflow as well as provide imaging of the artery in the popliteal space.
The treatment options include primary surgical revascularization, thrombolytic therapy, percutanous mechanical thrombectomy or a combination of any of the three. Clinicians who themselves have the skills to perform a wide assortment of interventions ranging from percutanous therapies through open surgical revascularization are best able to arrive at the most rational option for treating a specific clinical scenario. Only in this manner we expect to reduce the high rate of morbidity and mortality that remains associated with these events.
Percutanous methods designed to remove the intraluminal thrombus offer an alternative to immediate open surgical revascularization. These less invasive techniques constitute an option that is better tolerated in medically compromised patients. The causative lesion can be precisely identified and the patency of outflow vessels can be restored. The lesion can then be addressed on an elective basis in a well-prepared patient, using percutanous or open surgical techniques to affect a durable long-term solution.
Failure to restore adequate arterial flow in a timely fashion can result in the development of irreversible tissue infarction and the opportunity for limb salvage is lost. On the other hand, patients with acute limb ischemia are often elderly and early invasive open surgical procedures without adequate preoperative stabilization and preparation result in unacceptably high risk of perioperative cardiopulmonary complications and death.
While mortality occurs as a result of concurrent medical co-morbidities and the fragile baseline medical state of the patient, Limb loss is related to unsuccessful revascularization procedure.
The practicing vascular surgeon must become familiar with a broad spectrum of novel therapeutic techniques and regimens, some of them surgical, some pharmacologic and yet others endovascular techniques.