Aneurysms, femoral and popliteal
Aneurysms, femoral and popliteal: Excerpt from Handbook of Diseases
Femoral and popliteal aneurysms result from progressive atherosclerotic changes occurring in the walls (medial layer) of the major peripheral arteries. Aneurysmal formations may be fusiform (spindle shaped) or saccular (pouchlike), with the fusiform type being three times more common than the saccular type. These formations may be single or multiple segmental lesions, in many cases affecting both legs, and may accompany other arterial aneurysms located in the abdominal aorta or iliac arteries.
This condition is most common in men older than age 50. The clinical course is usually progressive, eventually ending in thrombosis, embolization, and gangrene. Elective surgery before complications arise greatly improves the prognosis.
Causes
Femoral and popliteal aneurysms are usually secondary to atherosclerosis. Rarely, they result from congenital weakness in the arterial wall. They may also result from trauma (blunt or penetrating), bacterial infection, or peripheral vascular reconstructive surgery (which causes “suture line” aneurysms, whereby a blood clot forms a second lumen, also called false aneurysms).
Signs and symptoms
Popliteal aneurysms may cause pain in the popliteal space when they’re large enough to compress the medial popliteal nerve, and edema and venous distention when the vein is compressed. Femoral and popliteal aneurysms can produce symptoms of severe ischemia in the leg or foot, due to acute thrombosis within the aneurysmal sac, embolization of mural thrombus fragments and, rarely, rupture.
Signs and symptoms of acute aneurysmal thrombosis include severe pain, loss of pulse and color, coldness in the affected leg or foot, and gangrene. Distal petechial hemorrhages may develop from aneurysmal emboli.
Diagnosis
With femoral aneurysm, the diagnosis is usually confirmed by bilateral palpation that reveals a pulsating mass above or below the inguinal ligament. When thrombosis has occurred, palpation detects a firm, nonpulsating mass.
Arteriography or ultrasonography may be indicated in doubtful situations. Arteriography may also detect associated aneurysms, especially those in the abdominal aorta and the iliac arteries. Ultrasonography may be helpful in determining the size of the femoral or popliteal aneurysm.
Treatment
Femoral and popliteal aneurysms require surgical bypass and reconstruction of the artery, usually with an autogenous saphenous vein graft replacement. Arterial occlusion that causes severe ischemia and gangrene may require leg amputation.
Special considerations
Before corrective surgery, perform the following:
Evaluate the patient’s circulatory status, noting the location and quality of peripheral pulses in the affected arm or leg.
Administer a prophylactic antibiotic or anticoagulant as needed.
Discuss expected postoperative procedures with the patient, and review the surgical procedure.
After arterial surgery, perform the following:
Carefully monitor the patient for early signs and symptoms of thrombosis or graft occlusion (loss of pulse, decreased skin temperature or sensation, or severe pain) and infection (fever).
Palpate distal pulses at least every hour for the first 24 hours, then as frequently as needed. Correlate these findings with preoperative circulatory assessment. Mark the sites on the patient’s skin where pulses are palpable, to facilitate repeated checks.
Help the patient walk soon after surgery, to prevent venostasis and thrombus formation.
To prepare the patient for discharge, perform the following:
Tell the patient to immediately inform the physician of any recurrence of symptoms because the saphenous vein graft replacement can fail or another aneurysm may develop.
If the patient has undergone a popliteal artery resection, explain to him that swelling may persist for some time. If antiembolism stockings are prescribed, make sure they fit properly, and teach the patient how to apply them. Warn against wearing constrictive apparel.
If the patient is receiving an anticoagulant, suggest measures to prevent bleeding, such as using an electric razor. Tell the patient to report signs of bleeding immediately (bleeding gums, easy bruising, or black, tarry stools).
Explain the importance of follow-up blood studies to monitor anticoagulant therapy. Warn the patient to avoid trauma, tobacco, and aspirin.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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