Spontaneous popliteal artery dissection: a case report and review of the literature

Spontaneous non-aneurysmal popliteal artery dissection managed without operative treatment: A case report and literature review

OBJECTIVES

Primary arterial dissection in peripheral arteries of the extremities is exceedingly rare. Isolated dissection of peripheral arteries (femoropopliteal or popliteal) primarily has been reported in aneurysmal arteries. Spontaneous dissection limited to a non-aneurysmal popliteal artery was first described in 1999 by Rabkin et al.

METHODS

We report a case of a non-aneurysmal popliteal artery dissection to emphasize its rare condition.

RESULTS

A 61-year-old man consulted because of sudden onset of pain and cramps in his left leg after walking 60 metres. A high-resolution duplex ultrasonography could identify a dissection of a non-aneurysmal popliteal artery. Computed tomography angiography could confirm the diagnosis. An operative repair was scheduled 3 weeks later and the patient was put on antiplatelet medication (acetylsalicylic acid 80 mg 1x/day) in the meantime. After 3 weeks the dissection was resolved spontaneously and the patient didn't undergo surgery. Check-ups remained reassuring and we scheduled a duplex ultrasonography within one year. Antiplatelet medication was continued.

CONCLUSIONS

Spontaneous dissection limited to a non-aneurysmal popliteal artery is extremely rare. Diagnosis can be made by duplex ultrasonography and/or CT angiography. Treatment options consist of conservative management or operative treatment. Operative treatments consist of an open repair with bypass or interposition graft or minimal invasive endovascular stent grafting. A standardized protocol for conservative treatment in this specific condition is not available. Annual follow-up of these patients is essential.

Transient Acute Leg Ischemia in a Professional Athlete Caused by Isolated Popliteal Artery Dissection Mimicking Popliteal Entrapment Syndrome

Exertional leg pain includes a broad range of conditions induced by different vascular, musculoskeletal, and neurological disorders. We report a case with isolated popliteal artery dissection as a cause of a transient acute lower limb ischemia. We report a patient with popliteal artery dissection which occurred during squatting exercise. After initial signs of transient acute limb ischemia, physical and ultrasound examination pointed to entrampment syndrome as a likely cause. However, digital subtraction angiography showed possible dissection of popliteal artery, which was confirmed intraoperatively. Popliteal artery was resected and reversed saphenous vein bypass was performed. Isolated popliteal artery dissection in professional athletes is a rare entity, which can be manifested with exertional leg pain. Clinical findings can sometimes be similar to those of popliteal entrapment syndrome. Clinical suspicion and timely patient referral to a vascular specialist are crucial for optimal treatment of this limb-threatening condition.

Isolated dissection of a non-aneurysmal popliteal artery

Two cases of isolated dissection of a non-aneurysmal, non-atherosclerotic popliteal artery are reported. Isolated dissection of the popliteal artery is a distinct entity that may have far reaching effects on patient's mobility if not adequately treated. This lesion can be seen in non-aneurysmal, non-atherosclerotic vessels and in patients with no predisposing medical causes. It requires a high degree of suspicion for diagnosis because of its rarity. Surgical treatment is the best option and results in a good outcome.

Spontaneous superficial femoral artery dissection with distal embolization

Primary arterial dissection of the peripheral vessels is a rare condition. We report a case of spontaneous dissection of the distal superficial femoral artery compounded by distal embolization leading to ischemic symptoms. The patient was successfully treated with exploration of the superficial femoral artery over the area of the dissection, distal embolectomy, and reconstruction by way of an interposition graft. Awareness of this condition leads to potentially earlier diagnosis and expands the therapeutic options.