Objective To present and summarize the data concerning the diagnosis and treatment of popliteal aneurysm in our hospital. Methods The data of popliteal aneurysm in our hospital from 1975 to 2004 were reviewed and analyzed. Eleven patients with 11 diseased limbs were treated, including 8 males and 3 females, age from 21 years to 64 years 〔(48.54±13.66) years〕. The combined diseases include syphilis, rheumatic heart disease and chronic obstructire pulmonary disease etc. Ten patients received operations, including endoaneurysmorrhaphy (n=4) and graft bypass after aneurysmal resection (n=6), through posterior approach (n=7) or medial approach (n=3). One patient, combined with advanced syphilis and heart failure, received conservative treatment because of his poor general condition. Results The common clinical manifestations included popliteal pulsating mass, claudication, difficulty in extension of the knee, pain etc. Acute ischemia occurred in 3 limbs. The diameter of popliteal aneurysms varied from 4-13 cm 〔（6.73±2.69) cm〕. There were 3 (27.3%) cases of ruptured aneurysms whose diameters were 7 cm, 7 cm and 11 cm respectively. Special examinations included arteriography and Doppler sonography. Pathological results of these patients were pseudoaneurysm (n=3), syphilitic aneurysm (n=3) and atherosclerotic aneurysm (n=4). Two patients were not followed up, and postoperative follow up of the other 8 patients ranged from 18 months to 30 years. In the group of endoaneurysmorrhaphy, postoperative gangrene of the affected limb occurred in one patient, and above-knee amputation was performed. One patient suffered from intermittent claudication in the group of endoaneurysmorrhaphy and of graft bypass respectively. No manifestations of limb ischemia were found in the other 5 patients during the time of follow up. Conclusion General utilization of Doppler sonography in screening high risk patients might be helpful to detect popliteal aneurysm. For symptomatic popliteal aneurysm or asymptomatic popliteal aneurysm with diameter larger than 3 cm, operation is indicated. Asymptomatic popliteal aneurysms no more than 3 cm in diameter could be monitored with care.
ObjectiveTo identify risk factors for severe elastic recoil after percutaneous transluminal angioplasty (PTA) in the femoropopliteal artery disease based on intravascular ultrasound (IVUS) imaging and to develop a risk prediction model. MethodsA retrospective analysis was conducted on the clinical data from the patients with femoropopliteal artery disease treated at the First Affiliated Hospital of Chongqing Medical University from September 2020 to February 2022. Based on the IVUS images, a multivariate logistic regression analysis was conducted to identify the risk factors for severe elastic recoil in the patients with femoropopliteal artery disease after PTA. A nomogram prediction model was established to predict the occurrence of severe elastic recoil, and the area under receiver operating characteristic curve (AUC) was used to evaluate its ability to distinguish the occurrence of severe elastic recoil, which was validated using a calibration curve. ResultsA total of 34 patients with femoropopliteal artery disease who received PTA treatment were enrolled. Of the 803 vessel slices were analyzed, 451 (56.16%) demonstrated severe elastic recoil on IVUS imaging. The multivariate logistic regression analysis showed that the increased plaque burden, luminal eccentric index, external elastic membrane remodeling index, and the external elastic membrane-balloon area ratio were the risk factors for the occurrence of severe elastic recoil (P＜0.05). The AUC of the nomogram prediction model based on these risk factors exhibited moderate discrimination [AUC (95%CI)=0.775 (0.732, 0.818)]. The predicted probability of the nomogram model for severe elastic recoil was in a good agreement with the actual probability (P=0.862). ConclusionThe severe elastic recoil prediction model developed in this study, based on IVUS imaging data, can effectively identify high-risk factors for severe elastic recoil after PTA in patients with femoropopliteal artery disease, demonstrating a moderate predictive discrimination capability.
Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.