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Concept: Popliteal artery


OBJECTIVE: Endografts represent a relatively new treatment modality for occlusive disease of the superficial femoral artery, with promising results. However, endografts may occlude collateral arteries, which may affect outcome in case of failure. The purpose of this study was to analyze the clinical outcome of failed endografts in patients with superficial femoral artery occlusive disease. METHODS: All patients treated with one or more polytetrafluorethylene-covered stents between November 2001 and December 2011 were prospectively included in a database. Patients with a failure of the endograft were retrospectively analyzed. Clinical and hemodynamic parameters were assessed before the initial procedure and at the time of failure. Outcome of secondary procedures was analyzed. RESULTS: Among the 341 patients who were treated during the study period, 49 (14.4%) failed during follow-up. Mean (standard deviation) Rutherford category at failure did not differ from the category as scored before the initial procedure (3.1 [1.3] vs 3.3 [0.6]; P = .33). Forty-three percent of patients (n = 21) presented with the same Rutherford category as before the initial procedure, 37% (n = 18) with an improved category, and 20% (n = 10) with a deteriorated category. The ankle-brachial index was significantly lower at the time of failure (0.66 [0.19] vs 0.45 [0.19[; P <.002). Seventy-six percent of patients with a failure needed secondary surgery, of which 25% were below knee. The 1-year primary, primary-assisted, and secondary patency rates of secondary bypasses were 55.1%, 62.3%, and 77.7%, respectively. The amputation rate was 4.1% (n = 2). CONCLUSIONS: Failure of endografts is not associated with a deterioration in clinical state and is related to a low amputation rate. The hypothesis that covered stents do not affect options for secondary reconstructions could not be confirmed, as 25% of patients with a failure underwent a below-knee bypass. Secondary surgical bypasses are correlated with poor patency. The amputation rate after failure is low.

Concepts: Coronary artery bypass surgery, Femoral artery, Femoral vein, External iliac artery, Superficial iliac circumflex artery, Popliteal artery, Femoral triangle


BACKGROUND: The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. METHODS: In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. FINDINGS: The knee experienced mean peak loadings of 2.4-4.6×body weight at the patellofemoral joint, 6.9-9.0×body weight at the tibiofemoral joint, 0.3-1.4×body weight anterior tibial shear and 1.0-3.1×body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4×body weight and the ankle 8.9-10.0×body weight. INTERPRETATION: The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations.

Concepts: Knee, Joint, Sartorius muscle, Knowledge, Synovial joint, Joints, Human leg, Popliteal artery


Objectives. To summarize available evidence regarding stent fracture in the femoropopliteal region. Methods. We searched PubMed, 2000-2011, using MeSH search terms “stents,” “popliteal artery,” and “femoral artery.” Results. We identified 29 original studies reporting 0% to 65% incidence of stent fracture. Fracture-related repeat revascularization could be avoided in the absence of device failure. Recently published data suggest that even a 5% rate of fracture-related reintervention would generate $118.4 million in health care cost in the United States. These excess procedures would also result in major complications and deaths that might have been avoided in the absence of stent fracture. Conclusions. Reported incidence and clinical relevance of femoropopliteal stent fractures vary across studies. Stent fracture may lead to repeat revascularization. These reinterventions create considerable-and potentially avoidable-economic burden for patients and payers. Further, these costs are effectively invisible wherever stent fractures are not systematically documented as the reason for reintervention.

Concepts: Pulse, Femoral artery, Popliteal artery


Complex lesions within the femoro–popliteal vascular territory, amongst others, include more than 15cm long or heavily calcified occlusions of the superficial femoral artery (SFA) or total occlusions of the popliteal artery (PA). For those Type–C/–D lesions TASC–II recommendations originating from 2007 advocate bypass surgery as the therapy of choice if the patient is a suitable candidate for this. Against the background of evolving endovascular techniques which often allow recanalization of even long and calcified lesions as well as improved patency rates after endovascular treatment ofsuch complex lesions, many vascular specialists go for an endovascular–first approach for the treatment of challenging lesions, last but not least in those patients unfit for surgery or in those lacking an adequate conduit or distal target vessel segment. This review focuses on two important aspects of treating complex femoro–popliteal lesions by an endovascular approach. The first part covers techniques to pass a complex lesion with a guidewire, while the second discusses strategies to improve the outcome of the endovascular reconstruction in terms of patency and clinical success.

Concepts: Pulse, Coronary artery bypass surgery, Femoral artery, Femoral vein, Arteries of the lower limb, External iliac artery, Popliteal artery, Popliteal vein


Bone nonunion in the pediatric population usually occurs in the context of highly unfavorable biological conditions. Recently, the vascularized fibular periosteal flap has been reported as a very effective procedure for treating this condition. Even though a vascularized tibial periosteal graft (VTPG) was described long ago and has been successfully employed in one adult case, there has been no other report published on the use of this technique. We report on the use of VTPG, pedicled in the anterior tibial vessels, for the treatment of two complex pediatric bone nonunion case: a recalcitrant supracondylar femoral pseudarthrosis secondary to an infection in an 11-year-old girl, and a tibial nonunion secondary to a failed bone defect reconstruction in a 12-year-old girl. Rapid healing was obtained in both cases. In the light of the data presented, we consider VTPG as a valuable surgical option for the treatment of complex bone nonunions in children. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014.

Concepts: Surgery, Report, Case, Complex analysis, Popliteal artery, Nonunion, Fibular artery, Anterior tibial artery


-Drug-coated balloons (DCB) have shown promise in improving outcomes for patients with peripheral artery disease. We compared a paclitaxel-coated balloon with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic superficial femoral and/or popliteal artery disease.

Concepts: Atherosclerosis, Cardiology, Pulse, Angioplasty, Femoral artery, Balloon, Popliteal artery, Popliteal vein


Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA.

Concepts: Knee, Anterior cruciate ligament, Knee replacement, Computational sociology, Cruciate ligament, Popliteal artery


This study investigated exercise-induced effects of static stretching and playing soccer on anterior tibial translation (ATT) of the knee joint.

Concepts: Osteoarthritis, Knee, Joint, Synovial joint, Joints, Stretching, Popliteal artery


Popliteal artery stenting is not routinely performed due to concerns related to the high mobility of the knee joint and the potential for external stent compression, fractures, and occlusion. Open bypass is traditionally considered the gold standard for popliteal artery atherosclerotic lesions. The Supera stent (IDEV Technologies Inc, Webster, Tex) was developed to provide superior radial strength, fracture resistance, and flexibility compared with laser-cut nitinol stents. This study represents the initial United States experience in the management of popliteal artery atherosclerotic disease with the Supera interwoven wire stent.

Concepts: Atherosclerosis, United States, Fracture mechanics, Stent, Knee, Joint, Coronary artery bypass surgery, Popliteal artery


This systematic review compared outcomes between endovascular and open repair of asymptomatic popliteal artery aneurysms (PAAs). Endovascular repair was associated with increased 30-day graft occlusion (odds ratio [OR] = 3.14; 95% confidence interval [CI], 1.43-6.92) and increased 30-day reintervention (OR = 4.09; 95% CI, 2.79-6.00). The 12-month primary patency rate was significantly higher in the open repair group (hazard ratio = 1.95; 95% CI, 1.14-3.33). Endovascular repair was associated with shorter length of hospital stay (mean difference = -3 d; 95% CI, -4.09 to -1.91; P < .001). Endovascular repair is associated with inferior perioperative and postoperative outcomes compared with open repair.

Concepts: Epidemiology, Statistics, Medical statistics, Odds ratio, Interval finite element, Probability theory, Confidence interval, Popliteal artery