Femoral and popliteal aneurysms
Femoral and popliteal aneurysms: Excerpt from Professional Guide to Diseases (Eighth Edition)
Femoral and popliteal aneurysms (sometimes called peripheral arterial aneurysms) are the end result of progressive atherosclerotic changes occurring in the walls (medial layer) of these major peripheral arteries. These aneurysmal formations may be fusiform (spindle-shaped) or saccular (pouchlike); the fusiform type is three times more common. They may be singular or multiple segmental lesions, often affecting both legs, and may accompany other arterial aneurysms located in the abdominal aorta or iliac arteries. (See Arteries of the leg, page 1142.)
This condition occurs most frequently 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, or false aneurysms, in which a blood clot forms a second lumen).
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 if 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. 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
Diagnosis is usually confirmed by bilateral palpation that reveals a pulsating mass above or below the inguinal ligament in femoral aneurysm. When thrombosis has occurred, palpation detects a firm, nonpulsating mass. Arteriography or ultrasound may be indicated in doubtful situations. Arteriography may also detect associated aneurysms, especially those in the abdominal aorta and the iliac arteries. Ultrasound may be helpful in determining the size of the popliteal or femoral artery.
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:
❑ Assess and record circulatory status, noting the location and quality of peripheral pulses in the affected arm or leg.
❑ Administer prophylactic antibiotics or anticoagulants, as ordered.
❑ Discuss expected postoperative procedures and review the explanation of the surgery.
After arterial surgery:
❑ Monitor carefully for early signs of thrombosis or graft occlusion (loss of pulse, decreased skin temperature and sensation, and severe pain) and infection (fever).
❑ Palpate distal pulses at least every hour for the first 24 hours and then as frequently as ordered. 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 possible thrombus formation.
To prepare the patient for discharge:
❑ Tell the patient to immediately report any recurrence of symptoms because the saphenous vein graft replacement can fail or another aneurysm may develop.
❑ Explain to the patient with popliteal artery resection that swelling may persist for some time. If antiembolism stockings are ordered, make sure they fit properly and teach the patient how to apply them. Warn against wearing constrictive apparel.
❑ If the patient is receiving anticoagulants, suggest measures to prevent bleeding such as using an electric razor. Tell him to report any signs of bleeding immediately (bleeding gums, tarry stools, and easy bruising). Explain the importance of follow-up blood studies to monitor anticoagulant therapy. Warn him to avoid trauma, tobacco, and aspirin.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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