Femoral and Popliteal Aneurysms
Because they occur in the two major peripheral arteries, femoral and popliteal aneurysms are also known as peripheral arterial aneurysms. They may be fusiform (spindle–shaped) or saccular (pouchlike). Fusiform types are three times more common than saccular forms. They may be singular or multiple segmental lesions, often affecting both legs, and may accompany other arterial aneurysms located in the abdominal aorta or the iliac arteries.
This condition is most common in males older than age 50. Elective surgery before complications arise greatly improves the prognosis.
Causes
Femoral and popliteal aneurysms usually result from progressive atherosclerotic changes in the arterial walls (medial layer). 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, also called false aneurysms, whereby a blood clot forms a second lumen).
Complications
If thrombosis, emboli, or gangrene occur, poor tissue perfusion to areas distal to the aneurysm may require amputation.
Assessment
The patient may complain of pain in the popliteal space when a popliteal aneurysm is large enough to compress the medial popliteal nerve. Inspection may reveal edema and venous distention if the vein is compressed.
Femoral and popliteal aneurysms can produce signs and symptoms of severe ischemia in the leg or foot resulting from acute thrombosis within the aneurysmal sac, embolization of mural thrombus fragments and, rarely, rupture.
In acute aneurysmal thrombosis, the patient may complain of severe pain. Inspection may reveal distal petechial hemorrhages from aneurysmal emboli. The affected leg or foot may show loss of color. Palpation of the affected leg or foot may indicate coldness and a loss of pulse. Gangrene may develop.
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