Diagnostic Steps of Investigation

• A physical examination can help in reaching patients in whom a PA is suspected, such as the presence of a pulsating mass in the popliteal fossa. Feeling a space-occupying mass (whether it is pulsatile or not) in the popliteal region and symptoms of acute ischaemia of the limb, blue toe syndrome, a clinical picture of extrinsic compression, etc. will help lead to diagnosis.

• Doppler ultrasound will confirm the diagnosis and enable measurement of the size of the aneurysm. It will also provide data on patency and the presence of mural thrombus (Figs. 7.4.1, 7.4.2). At the same time, it allows exploration of the contralateral popliteal artery and the aorta. Doppler ultrasound is the ideal test for screening, as it is easy to use, comfortable for the patient and has a high degree of cost-effectiveness.

• Both magnetic resonance imaging (MRI) and computerized tomography (CT scan) are very accurate methods for accurately determining its location, size and patency. They define the thickness of the mural thrombus filling the aneurysmal sac. Nevertheless, their use must be restricted where surgery may be an indication.

• Angiography is useful in planning the surgical treatment for extremities affected by symptoms of isch-aemia; in fact, it is the best test for an accurate evaluation of the distal run-off as well as for choosing the best arterial segment for performing the distal anastomoses. In addition, in patients with acute ischaemia secondary to thrombosis, it also allows locoregional fibrinolytic therapy to be performed in order to improve distal run-off. However, angiography is not a good technique for diagnosing a PA as it only identifies the arterial lumen.

For this reason prophylactic surgical repair is frequently recommended, especially when considering the high rate of amputation in cases when thrombosis of the aneurysm occurs.

In general terms, intervention is recommended in asymptomatic aneurysms larger than 2 cm in diameter with mural thrombus and anatomical distortion. In the remaining cases, conservative treatment is advised and surgery is only recommended when symptoms appear or if enlargement of the diameter takes place.

Symptomatic Aneurysms

Fig. 7.4.1 Doppler ultrasound imaging of a popliteal aneurysm. The artery is shown in red and the vein in blue. In this transverse cut the low density surrounding the vessels shows the an-eurysm

Symptomatic Aneurysms

Fig. 7.4.1 Doppler ultrasound imaging of a popliteal aneurysm. The artery is shown in red and the vein in blue. In this transverse cut the low density surrounding the vessels shows the an-eurysm

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Map 2 LSOdBiC J Persist Med 2D QptGon Col 79V. Map 1 «VF Low PRF2500 Ki FkwOptMedV

05/DZr 14:175403 HOSPITAL OE BELLVLTGE L12-5 18 PVusclArl

Map 2 LSOdBiC J Persist Med 2D QptGon Col 79V. Map 1 «VF Low PRF2500 Ki FkwOptMedV

Fig. 7.4.2 The same case in a longitudinal image. Observe the thickness of the mural thrombus

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