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Bertalan MS, Ghaffarian A, Hemingway J, Quiroga E, Tran N, Starnes B, Singh N. Surgical release of anterior tibial artery entrapment with associated popliteal artery entrapment. J Vasc Surg Cases Innov Tech 2024; 10:101395. [PMID: 38304294 PMCID: PMC10830487 DOI: 10.1016/j.jvscit.2023.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
Popliteal artery entrapment syndrome (PAES) is compression of the popliteal artery from embryologic myotendinous variation or calf muscle hypertrophy. PAES necessitates prompt diagnosis and complete release of the entrapped vasculature for symptom relief and to prevent chronic cumulative vascular damage. Our patient is a 27-year-old female referred for progressive bilateral claudication. Workup was consistent with bilateral PAES with preoperative imaging notable for an atypically proximal origin of the anterior tibial artery, which was also encased anterior to the popliteus muscle. Preoperative angiogram confirmed the diagnosis, and complete surgical release resolved symptoms by 4 months postoperatively.
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Affiliation(s)
- Mia S. Bertalan
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Amir Ghaffarian
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Jake Hemingway
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Elina Quiroga
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Nam Tran
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Benjamin Starnes
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
| | - Niten Singh
- Division of Vascular Surgery, Department of General Surgery, University of Washington, Harborview Medical Center, Seattle, WA
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Rebelo A, Partsakhashvili J, Ronellenfitsch U, John E, Kleeff J, Ukkat J. Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair. Vascular 2024; 32:32-41. [PMID: 38308424 DOI: 10.1177/17085381221126318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. METHODS A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg. RESULTS We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group. CONCLUSION Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.
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Affiliation(s)
- Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jumber Partsakhashvili
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Endres John
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Ukkat
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
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Jung G, Leinweber ME, Karl T, Geisbüsch P, Balzer K, Schmandra T, Dietrich T, Derwich W, Gray D, Schmitz-Rixen T. Real-world data of popliteal artery aneurysm treatment. Analysis of the POPART registry. J Vasc Surg 2022; 75:1707-1717.e2. [PMID: 35066058 DOI: 10.1016/j.jvs.2021.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Popliteal artery aneurysm (PAA) is a rare disease with a prevalence of 0.1-1%. Within the last years, endovascular repair of PAA (ER) has been performed more frequently despite the lack of high-level evidence compared to open surgery (OR). In 2014, the POPART registry was initiated to validate current treatment options in PAA repair.
METHOD: POPART is a multinational multicenter registry for peri- and postoperative outcome of endovascular and open PAA repair. Data sets are recorded by the online survey tool "SurveyMonkey®". Regular monitoring and plausibility checks of the data sets are performed to ensure reliability. The aim of this study is to present results of the POPART registry, with data of 41 centers.
RESULTS: From June 2014 to August 2019, a total of 794 cases were recorded in the PAA registry. OR was performed in 662 patients and ER in 106 patients; 23 Patients were treated conservatively. Four of the 106 patients with primary ER underwent conversion to OR. ER patients were significantly older (ER x˜= 71 vs. OR x˜= 67 (p<0.05). There were no other significant differences in demographics or comorbidities and aneurysm morphology between the two groups. 50.3% patients in the OR group were symptomatic; in the ER group 29.2% (p<0.05). Emergency treatment for acute ischemia, critical ischemia or rupture was necessary in 149 patients (22.5%) in the OR group vs. 11 patients (10.3%) in the ER group.
Most frequent complications after surgery were impaired wound healing (OR n=47, 7.1%; ER n=3, 2.8%, p>0.05) and major bleeding (OR n=26, 3.9%; ER n=3, 2.8%, p>0.05). In-hospital length of stay (= 10d [3-65] OR vs. x˜=7d [1-73] ER) was significantly higher in the OR group. Overall patency was 83.2% vs. 44.7% (OR/ER, p<0.005) after 12 months and 74.2% vs. 29.1% (OR/ER, p<0.005) after 24 months. There was a significantly poorer outcome for prosthetic graft compared to autologous vein in the OR group (71.4% vs. 88.1% 12-month primary patency).
CONCLUSION:
In order to evaluate new treatment techniques such as endovascular repair (ER) for PAA, real world data is of essential importance. This analysis of the first results for the POPART registry shows good perioperative results for endovascular treatment of PAA in asymptomatic patients with good outflow vessels. The perioperative complication rate is low and the postoperative hospital stay is shorter than after OR. However, the patency rates after 12 and 24 months are low in the ER group compared to patients treated with open repair. More follow-up data is required for further interpretation; the completion of the data sets in the registry is ongoing.
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Affiliation(s)
- Georg Jung
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany.
| | - Maria-Elisabeth Leinweber
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart- Katharinenhospital, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St.-Marien-Hospital, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular and Endovascular Surgery, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
| | - Tanja Dietrich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Daphne Gray
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany; German Institute of Vascular Public Health Research, Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG), Berlin, Germany
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Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
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Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
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da Silva MOM, Amorim Santos H, da Silva AFV, Marum G, de Godoy JMP. Thrombosis of the right iliac, femoral, popliteal, and tibial arteries in a post-COVID-19 in adolescent. Ann Pediatr Surg 2021; 17:57. [PMID: 34899882 PMCID: PMC8422057 DOI: 10.1186/s43159-021-00124-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background Viral infection into lung, muscular, and endothelial cells results in inflammatory response, including edema, degeneration, and necrotic alterations. The involvement of the major arteries in adolescent with COVID-19 has been infrequently reported in the literature. The aim of the present study is to report thrombosis of the right iliac, femoral and tibial arteries and stenosis of left iliac artery in an adolescent with COVID-19 and to discuss the pathophysiological hypotheses. Case presentation We report the case of a 17-year-old female patient with COVID-19 infection. She was seen at the physician specialized general medicine in her hometown, was diagnosed with COVID-19 but did not require hospitalization. After 15 days, she had sudden pain in the left leg that has limited her ability to walk more than 10 met, associated with extremity cyanosis and coldness. Angiotomography revealed thrombosis of a portion of the iliac and popliteal arteries. Na emergency embolectomy was successfully performed, followed by full-dose heparinization with unfractionated heparin. Conclusion Arterial thrombosis of large arteries may be associated with chronic inflammatory syndrome secondary to COVID-19 infection and the treatment with a late embolectomy was successful, even in a thrombotic event.
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Affiliation(s)
| | - Henrique Amorim Santos
- Service Vascular Surgery, Medicine School in Sao Jose do Rio Preto (FAMERP), São Jose do Rio Preto, Brazil
| | | | - Guilherme Marum
- Service Vascular Surgery, Medicine School in Sao Jose do Rio Preto (FAMERP), São Jose do Rio Preto, Brazil
| | - Jose Maria Pereira de Godoy
- Cardiology and Cardiovascular Surgery Department in Medicine School of Sao Jose do Rio Preto-FAMERP, São Jose do Rio Preto, Brazil.,CNPq (National Council for Research and Development), Rua Floriano Peixoto, São Jose do Rio Preto, SP 2950 Brazil
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Beuschel B, Nayfeh T, Kunbaz A, Haddad A, Alzuabi M, Vindhyal S, Farber A, Murad MH. A systematic review and meta-analysis of treatment and natural history of popliteal artery aneurysms. J Vasc Surg 2021; 75:121S-125S.e14. [PMID: 34058308 DOI: 10.1016/j.jvs.2021.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize the best available evidence comparing open vs endovascular popliteal artery aneurysm (PAA) repair. We also summarized the natural history of PAAs to support of the Society for Vascular Surgery guidelines. METHODS We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate. RESULTS We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30 days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3 years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30 days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. One study showed that at 5 years, approximately one-half of the patients had complications. CONCLUSIONS This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.
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Affiliation(s)
- Brad Beuschel
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Tarek Nayfeh
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Ahmad Kunbaz
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Abdullah Haddad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Muayad Alzuabi
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Shravani Vindhyal
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn.
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Adams E, Mousa AY. Achieving a popliteal venous access for renal replacement therapy in critically ill COVID-19 patient in prone position. J Vasc Surg Cases Innov Tech 2020; 6:266-268. [PMID: 32322766 PMCID: PMC7175846 DOI: 10.1016/j.jvscit.2020.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/06/2023]
Abstract
This patient is a 67-year-old man who initially presented to our facility with acute respiratory failure secondary to COVID-19. Soon after arrival at our facility, the patient decompensated, developing severe acute respiratory distress syndrome requiring intubation and prone positioning to maintain adequate oxygenation. During the next few days, acute kidney injury with oliguria and severe volume overload developed. The vascular surgery service was consulted to obtain central venous access for emergent continuous renal replacement therapy. On examination, the patient was sedated and paralyzed in a rotating prone-positioning bed. He could not be positioned supine without immediately becoming hypoxic and decompensating. A 50-cm Permcath (Medtronic, Santa Rosa, Calif) was inserted through the left popliteal vein. This case report outlines a possible challenging scenario that the vascular interventionist may encounter in dealing with COVID-19 patients with respiratory compromise in the prone position.
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Affiliation(s)
- Elliot Adams
- Department of Surgery and Vascular Surgery, Robert C. Byrd Health Sciences Center/West Virginia University Charleston Area Medical Center, Charleston, WV
| | - Albeir Y Mousa
- Department of Surgery and Vascular Surgery, Robert C. Byrd Health Sciences Center/West Virginia University Charleston Area Medical Center, Charleston, WV
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Elliott JE, Jenkins J. Management of a large ruptured popliteal artery aneurysm involving combined deployment of a covered stent graft and evacuation of popliteal fossa hematoma. J Vasc Surg Cases Innov Tech 2020; 6:27-30. [PMID: 32055759 PMCID: PMC7005480 DOI: 10.1016/j.jvscit.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
Popliteal artery aneurysms (PAAs) are the most common of all peripheral aneurysms. However, ruptured PAA is rare, accounting for approximately 2% of PAA presentations. A literature review found only 11 published cases of ruptured PAAs treated with endovascular repair. In this case, a large (6.9 cm in diameter) ruptured PAA was successfully treated with endovascular repair using the GORE VIABAHN (W. L. Gore & Associates, Flagstaff, Ariz) stent graft and had simultaneous evacuation of popliteal fossa hematoma through a medial distal thigh incision. This facilitated more rapid recovery of mobility, reduced pain, and reduced hospital stay and may represent a useful hybrid surgical approach for this rare condition.
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Affiliation(s)
- James Edward Elliott
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jason Jenkins
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Byerly S, Cheng V, Plotkin A, Matsushima K, Inaba K, Magee GA. Impact of ligation versus repair of isolated popliteal vein injuries on in-hospital outcomes in trauma patients. J Vasc Surg Venous Lymphat Disord 2019; 8:437-444. [PMID: 31843477 DOI: 10.1016/j.jvsv.2019.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Popliteal vascular injuries are common and frequently associated with limb loss. Although many studies have evaluated the treatment and outcomes of popliteal artery injuries (PAI), there is little available evidence regarding popliteal venous injuries (PVI). As such, substantial debate remains regarding the benefit of repair over ligation of PVI. The objectives of this study were to compare in-hospital outcomes of repair versus ligation of isolated PVI, as well as to determine nonvascular factors associated with worse outcomes. METHODS Patients in the National Trauma Databank from 2007 to 2014 with at least one PVI were evaluated. First, patients with concomitant PVI and PAI were compared with patients with isolated PVI. Second, outcomes were compared between ligation and repair of isolated PVI. To limit the impact of concomitant injuries and focus on the impact of venous injury management, we defined isolated PVI as cases without concomitant PAI and with Abbreviated Injury Scale severity score of less than 3 for all body regions other than lower extremity. Patients dead on arrival and those with less than 18 years of age were excluded. The primary outcomes were in-hospital mortality, amputation, and in-hospital amputation-free survival (AFS). Secondary outcomes included lower extremity compartment syndrome, fasciotomy, acute kidney injury, pulmonary embolism, deep venous thrombosis, and inferior vena cava filter placement. RESULTS Overall, 1819 patients (0.03%) had a PVI and after exclusion 1213 met the criteria for initial analysis. Of those, 308 had isolated PVI, and 905 had combined PVI and PAI. Patients with combined PVI and PAI had higher rates of amputation (15.2% vs 6.8%; P < .001), fasciotomy (64.5% vs 30.8%; P < .001), compartment syndrome (14.8% vs 8.8%; P = .006), and a lower AFS (82.9% vs 91.8%; P < .001) than patients with isolated PVI. There was no difference in in-hospital mortality, amputation, or in-hospital AFS between ligation and repair of isolated PVI. On multivariable logistic regression of isolated PVI, ligation was not independently associated with in-hospital AFS, amputation, or mortality. CONCLUSIONS Ligation of isolated PVI was not an independent predictor of in-hospital mortality, lower extremity amputation, or in-hospital AFS. Ligation also did not result in higher rates of fasciotomy, acute kidney injury, or pulmonary embolism.
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Affiliation(s)
- Saskya Byerly
- Division of Trauma and Critical Care, Department of Surgery, University of Miami, Jackson Memorial Hospital Ryder Trauma Center, Miami, Fla
| | - Vincent Cheng
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Kazuhide Matsushima
- Division of Trauma and Critical Care, Department of Surgery, Keck School of Medicine, Los Angeles County Hospital, Los Angeles, Calif
| | - Kenji Inaba
- Division of Trauma and Critical Care, Department of Surgery, Keck School of Medicine, Los Angeles County Hospital, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
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Magetsari RMSN, Irawan MNS. Surgery on aggressive fibroma of the posterior compartment of the knee: A case report. Int J Surg Case Rep 2019; 65:115-8. [PMID: 31704661 DOI: 10.1016/j.ijscr.2019.10.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Fibroma is a benign tumor. More than 99% fibroma arises from tendon sheaths or tendons. Aggressive Fibroma at posterior compartment knee is a rare case. This report presents one case of fibroma at posterior compartment of the knee with the treatment. CASE REPORT A boy with 4-year history of knee discomfort and lump at posterior knee joint, no history of infection and trauma. Physical examination revealed a mass (10 × 9 × 7 cm) with limited Range of Motion extension 30°, flexion 70°. MRI revealed a soft tissue mass at posterior knee compartment. Histologic examination showed a circumscribed and lobulated hypo cellular mass containing spindle cells diagnosed as aggressive fibroma. The patient underwent popliteal resection. An ellipse incision was made 2 cm margin of skin around the biopsy site. Fasciocutaneous flaps were created and retracted to expose the posterior compartment. The tumor had a partial well-defined capsule, popliteal artery and vein embedded and pressing the sciatic nerve. The tumor and enveloping muscles were elevated from the base of the compartment. The sciatic nerve was preserved with epineurotomy. The popliteal artery was reconstructed with saphenous veins graft. After the tumor was resected, the heads of gastrocnemius were sutured to each other and to the hamstring muscles to cover popliteal space. After one year postoperative, there was a good vascularization, no recurrence and neurological deficit with Musculoskeletal Tumour Society Scoring System 80%. CONCLUSION One year postoperative with popliteal resection surgery yields a good result. A follow-up is needed for risk of recurrence and malignancy.
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Abstract
Proper pain control is critical for ambulatory surgery. Regional anesthesia can decrease postoperative pain, improve patient satisfaction, and expedite patient discharge. This article discusses the techniques, clinical pearls, and potential pitfalls associated with those blocks, which are most useful in an ambulatory perioperative setting. Interscalene, supraclavicular, infraclavicular, axillary, paravertebral, erector spinae, pectoralis, serratus anterior, transversus abdominis plane, femoral, adductor canal, popliteal, interspace between the popliteal artery and capsule of the knee, and ankle blocks are described.
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Affiliation(s)
- Alberto E Ardon
- Department of Anesthesiology, University of Florida Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.
| | - Arun Prasad
- Department of Anesthesiology, University of Toronto, Women's College Hospital, Mc L 2-405, 399, Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Robert Lewis McClain
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, Duke University Medical Center, DUMC Box #3094, Stop #4, Durham, NC 27710, USA
| | - Karen C Nielsen
- Department of Anesthesiology, Duke University Medical Center, Duke University Medical Center, DUMC Box #3094, Stop #4, Durham, NC 27710, USA
| | - Roy Greengrass
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Alasaad M, Zaitoun A, Szpunar S, Lalonde T, Rosman HS, Mehta RH, Yamasaki H, Othman H. Association of Race with Long-Term Outcomes in Patients Undergoing Popliteal and Infra-Popliteal Percutaneous Peripheral Arterial Interventions. Cardiovasc Revasc Med 2019; 20:649-53. [PMID: 30401590 DOI: 10.1016/j.carrev.2018.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Race-related differences in clinical features, presentation, treatment and outcomes of patients with various cardiovascular diseases have been reported in previous studies. However, the long-term outcomes in black versus white patients with popliteal and/or infra-popliteal peripheral arterial disease (PAD) undergoing percutaneous peripheral vascular interventions (PVI) are not well known. METHODS AND RESULTS We retrospectively evaluated long-term outcomes in 696 patients (263 blacks and 433 whites) who underwent PVI for popliteal and/or infra-popliteal PAD at our institution between 2007 and 2012. When compared to white patients, black patients were younger (70 ± 11 vs. 72 ± 11; P = 0.002) and had more comorbidities: higher creatinine (2.04 ± 2.08 vs. 1.33 ± 1.16; P < 0.0001) with more ESRD (19% vs. 6%; P < 0.0001) and more diabetes (64% vs. 55%; P = 0.004). At mean follow-up of 36 ± 20 months, there was no statistically significant difference between black and white patients either in all-cause mortality (29% vs. 32%; P = 0.38) or in major amputation (4.4% vs. 4.2%; P = 0.88), respectively. In a multi-variate Cox proportional hazard model, repeat ipsilateral percutaneous revascularization or bypass were lower in black patients (HR = 0.64 [95% CI 0.46-0.89]; P = 0.007) and major adverse vascular events (MAVE) were lower in black patients as well (HR = 0.7 [95% CI 0.56-0.89]; P = 0.003). CONCLUSION Black patients undergoing popliteal or infra-popliteal PVI had similar mortality and major amputation, but lower repeat revascularization and MAVE compared to white patients. These data support the use of PVI in minorities despite higher baseline comorbidities and call for more research to understand the mechanisms underlying the high mortality irrespective of race.
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Busch A, Grimm C, Hartmann E, Paloschi V, Kickuth R, Lengquist M, Otto C, Eriksson P, Kellersmann R, Lorenz U, Maegdefessel L. Vessel wall morphology is equivalent for different artery types and localizations of advanced human aneurysms. Histochem Cell Biol 2017; 148:425-433. [PMID: 28478588 DOI: 10.1007/s00418-017-1575-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Aneurysm formation occurs most frequently as abdominal aortic aneurysm (AAA), but is also seen in other localizations like thoracic or peripheral aneurysm. While initial mechanisms for aneurysm induction remain elusive, observations from AAA samples show transmural inflammation with proteolytic imbalance and repair mechanisms triggered by the innate immune system. However, limited knowledge exists about aneurysm pathology, especially for others than AAA. We compared 42 AAA, 15 popliteal, 3 ascending aortic, five iliac, two femoral, two brachial, one visceral and two secondary aneurysms to non-aneurysmatic controls by histologic analysis, immunohistochemistry and cytokine expression. Muscular and elastic type arteries show a uniform way of aneurysm formation. All samples show similar morphology. The changes compared to controls are distinct and include matrix remodeling with smooth muscle cell phenotype switch and angiogenesis, adventitial lymphoid cell accumulation and M1 macrophage homing together with neutrophil inflammation. Inflammatory cytokines are up-regulated accordingly. Comparative analysis of different disease entities can identify characteristic pathomechanisms. The phenotype of human advanced aneurysm disease is observed for elastic and muscular type arteries, does not differ between disease localizations and might, thus, be a unique response of the vasculature to the still unknown trigger of aneurysm formation.
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Affiliation(s)
- Albert Busch
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany. .,Molecular Vascular Medicine Group, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden. .,Clinic for Vascular and Endovascular Surgery, Technical University Munich, Ismaninger Str 22, 81675, Munich, Germany.
| | - Caroline Grimm
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Elena Hartmann
- Institute of Pathology and Comprehensive Cancer Center (CCC) Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Valentina Paloschi
- Cardiovascular Medicine Unit, Center for Molecular MedicineKarolinska, University hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Christoph Otto
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Per Eriksson
- Cardiovascular Medicine Unit, Center for Molecular MedicineKarolinska, University hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Richard Kellersmann
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Udo Lorenz
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Lars Maegdefessel
- Molecular Vascular Medicine Group, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.,Clinic for Vascular and Endovascular Surgery, Technical University Munich, Ismaninger Str 22, 81675, Munich, Germany
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Stabile E, Magliulo F, Zhelev D, Chervenkoff V, Taeymans K, Goverde P, Losi MA, Giugliano G, Trimarco B, Esposito G. Interim analysis at 6months from the LEG-flow Drug Eluting Balloon for the treatment of femoro popliteal occlusions (LEG-DEB) registry. Int J Cardiol 2016; 223:654-5. [PMID: 27568985 DOI: 10.1016/j.ijcard.2016.08.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/06/2016] [Indexed: 11/23/2022]
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Madassery S, Turba UC, Arslan B. Role of Stent Grafts and Helical-Woven Bare-Metal Stents in the Superficial Femoral and Popliteal Arteries. Tech Vasc Interv Radiol 2016; 19:153-62. [PMID: 27423997 DOI: 10.1053/j.tvir.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral vascular disease (PVD) is a devastating medical problem that may lead to significant life alterations for patients, from simply limiting their daily activities to potential loss of limbs and eventual demise. Superficial femoral and popliteal arteries are significantly common locations for PVD sequelae to present itself, and owing to their length and mobile nature, treatment of these segments are quite challenging. Indications for PVD treatment include lifestyle-limiting claudication that is not responding to medical management, ischemic rest pain, nonhealing ulcers, and lower extremity gangrene. There is a wide variety of treatment options that include medical management, interventional, and surgical techniques. Interventional techniques include plain old balloon angioplasty, cryoplasty, drug-coated balloon angioplasty, self-expanding bare-nitinol stents, self-expanding covered stents, self-expanding drug-eluding stents, and a number of atherectomy devices (ie, laser, rotational, orbital, and excisional). The scope of this article is to review indications, patient selection, and deployment techniques of Viabahn and Supera self-expanding stents.
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Abstract
Although rare, popliteal vein aneurysms can lead to pulmonary emboli, which can be fatal. We present a case of a popliteal vein aneurysm in a 39-year-old female who presented with her third episode of pulmonary embolism despite being on anticoagulants. Computed Tomography Venogram demonstrated a large Popliteal Vein Aneurysm measuring 71×36×77 mm which was surgically repaired. According to the current literature, anticoagulation is insufficient therefore early surgical intervention is recommended as it is safe and effective.
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Affiliation(s)
- Joel Lim
- Department of Clinical Services, Royal Perth Hospital, Perth, Australia
| | - Martin Marshall
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Australia
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Beecher S, Alawy M, Elbakar A, Tubassam M. Incidental discovery of a long standing arteriovenous fistula after thrombectomy for acute lower limb ischaemia. Int J Surg Case Rep 2014; 5:1031-4. [PMID: 25460466 PMCID: PMC4275777 DOI: 10.1016/j.ijscr.2014.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 08/11/2014] [Accepted: 10/08/2014] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Arteriovenous fistula (AVF) is the abnormal connection between an artery and vein. Congenital AVF of the popliteal artery is very rare. PRESENTATION OF CASE 89 year old lady presented with right acute lower limb ischaemia. She had unilateral chronic venous hypertensive change in the right leg. Femoral embolectomy was performed. Backflow was achieved. Arteriotomy was closed. The patient's leg continued to deteriorate. She returned to theatre. On-table angiogram showed an occluded SFA. Thrombectomy was completed. SFA was patent but no blood flowed into the distal popliteal artery. A second on table angiogram revealed AVF between popliteal artery and vein. Dissection to the posterior aspect of the knee revealed the fistula. The vein was arterialized and enlarged. The AVF was ligated. Normal distal blood flow was achieved. Retrospectively we measured the leg lengths. Right leg was 3cm longer than the left. The right leg circumference was 7cm greater than the left. She reported chronic venous change from a young age. She did not report any history of trauma to the limb. DISCUSSION Popliteal artery to popliteal vein fistula is a rare. Trauma is the most common cause of popliteal AVF. Should the condition develop before closure of the epiphyses, there may be an increase in leg measurements. CONCLUSION We postulate that this case of AV fistula may be congenital due to discrepancy in leg measurements and unilateral chronic venous hypertensive change. Rarely persistent remnants of the embryonic sciatic artery can lead to arteriovenous anastomoses, which may be a possible aetiology.
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Affiliation(s)
- S Beecher
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland.
| | - M Alawy
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - A Elbakar
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - M Tubassam
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
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Michez D, Spinoit A, Quintart C. Localized hypertrophy of the semimembranosus muscle in a young athlete: a case report. Orthop Traumatol Surg Res 2013; 99:871-3. [PMID: 24094888 DOI: 10.1016/j.otsr.2013.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/10/2013] [Accepted: 06/21/2013] [Indexed: 02/02/2023]
Abstract
Popliteal fossa and distal thigh swellings have many causes in young active adult. Cysts are the main cause, but they may also evolve from fatty tissue, lymph nodes or the popliteal artery. Semimembranosus muscle hypertrophy, found in athletes and young active adults, is only rarely the main or only cause of swelling, and only four such cases are reported in the literature. The present article reports our experience in the management of a case of semimembranosus hypertrophy as the only cause of a swelling above the popliteal fossa, and its favorable evolution.
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Affiliation(s)
- D Michez
- Service de pédiatrie, centre hospitalier du Grand-Hornu, 63, route de Mons, 7301 Hornu, Belgium
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Jeon HJ, Park YC, Lee JN, Bae JS. Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery. Korean J Anesthesiol 2013; 64:321-6. [PMID: 23646241 PMCID: PMC3640164 DOI: 10.4097/kjae.2013.64.4.321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/19/2012] [Accepted: 09/22/2012] [Indexed: 11/16/2022] Open
Abstract
Background We compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery. Methods Forty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer. Results Procedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P < 0.01). Anesthesia-related complications such as hypotension, bradycardia, shivering, nausea/vomitting, post-dural puncture headache (PDPH) and urinary retension were observed in 15%, 10%, 5%, 5%, 10%, and 20% of patients in the spinal group, respectively. PSNB was not associated with these complications. Patient satisfaction was slightly higher for PSNB than for spinal anesthesia. In the PSNB group, patient satisfaction with postoperative pain-control was 95% above ordinary satisfaction. Conclusions Despite the long duration of the procedure, PSNB is relatively safe, provides an adequate level of anesthesia, effectively controls postoperative pain and reduces side effects. Therefore, PSNB could be a potential anesthetic technique for hallux valgus surgery.
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Affiliation(s)
- Hyun-Jun Jeon
- Department of Anesthesiology and Pain Medicine, St. Mary's Medical Center, Busan, Korea
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Abstract
Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It concludes by discussing the causes and management of posterior knee pain.
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Affiliation(s)
- S English
- Department of Anesthesiology and Perioperative Care, The University of California Irvine, Irvine, CA USA.
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