Management of Asymptomatic Popliteal Artery Aneurysms

AbstractPopliteal artery aneurysms (PAAs) are the most common peripheral artery aneurysms. They are frequently symptomatic and are associated with high rates of morbidity and limb loss. PAA can be treated by open or endovascular means, although there are no specified recommendations guiding treatment choice. This article delineates many of the differences between open and endovascular repair of asymptomatic PAA, and highlights several key articles comparing open and endovascular repair to guide decision making. Proper diagnosis and choice of repair can lead to good outcomes in the treatment of asymptomatic PAA.

Download Full-text

Endovascular repair of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery: case report and review of literature

Vascular ◽

10.1177/1708538113477799 ◽

2013 ◽

Vol 21 (2) ◽

pp. 102-104 ◽

Cited By ~ 5

Author(s):

Zachary Aburahma ◽

Stephen M Hass

Keyword(s):

Case Report ◽

Endovascular Repair ◽

Popliteal Artery ◽

Knee Surgery ◽

Review Of Literature ◽

Safe Alternative ◽

Arthroscopic Knee Surgery ◽

Arthroscopic Knee

We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery.

Download Full-text

Abstract 319: Effects of Muscle Stretching on Flow-Mediated Dilation of Popliteal Artery in Patients With Peripheral Artery Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.319 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Kazuki Hotta ◽

Wayne B Batchelor ◽

James Graven ◽

Vishal Dahya ◽

Thomas E Noel ◽

...

Keyword(s):

Endothelial Function ◽

Popliteal Artery ◽

Calf Muscle ◽

Walking Distance ◽

Flow Mediated Dilation ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Peripheral Artery ◽

Muscle Stretching ◽

Artery Disease

Patients with peripheral artery disease (PAD) frequently have walking impairment due to lower extremity claudication. Our preliminary results in a rat model of aging indicate that a program of daily calf muscle stretching improves endothelium-dependent dilation of soleus muscle arterioles and increases soleus muscle blood flow during exercise. However, the effects of muscle stretching on the function of arteries supplying the legs of PAD patients is unknown. We hypothesized that daily calf muscle stretching improves vascular endothelial function and walking distance in PAD patients. To test our hypothesis, a randomized, non-blinded, crossover study was performed. Four weeks of muscle stretching (30 min/d, 5 days/wk) and 4 weeks of sedentary lifestyle (no stretching) were performed in random order. Thirteen patients with PAD participated in this study (71 ± 2 years old; 7 males and 6 females). During the stretching intervention both ankle joints were maintained at 15o of dorsiflexion using ankle dorsiflexion splints to stretch their calf muscles at home. Flow-mediated dilation (FMD; dilation to post-occlusion reactive hyperemia) and nitroglycerin-induced dilation (dilation to sublingual 0.4 mg nitroglycerin) of the popliteal artery were measured after 4 weeks of muscle stretching and after the no stretching period using ultrasound. A six-minute walk test was also performed to obtain walking distance. After 4 weeks of muscle stretching, FMD and 6-minute walking distance significantly improved as compared to the values measured after 4 weeks of no stretching (FMD: 5.2 ± 0.6 % vs. 3.7 ± 0.4 %, P=0.003 stretching vs. no stretching, 6-minute walking distance: 355 ± 32 m vs. 311 ± 31 m, P=0.007, stretching vs. no stretching; mean ± SE). No difference in nitroglycerin-induced dilation was found between groups (10.9 ± 1.4 vs. 9.9 ± 1.1 %, P=0.54, stretching vs. no stretching). Percentage change of walking distance (%change = [(stretching - no stretching) / no stretching] x 100) significantly correlated with the %change of FMD (R 2 =0.65, P=0.03). These results indicate that static calf muscle stretching enhances vascular endothelial function of the popliteal artery, contributing to improvement of walking tolerance in PAD patients.

Download Full-text

Endovascular Repair of Blunt Popliteal Artery Injury via Retrograde Tibial Access

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.10.029 ◽

2012 ◽

Vol 56 (6) ◽

pp. 1819 ◽

Cited By ~ 1

Author(s):

Jeff Luh ◽

Lori Choi ◽

Charlie C. Cheng ◽

Z. Faisal Cheema ◽

Michael B. Silva

Keyword(s):

Endovascular Repair ◽

Popliteal Artery ◽

Artery Injury

Download Full-text

SP-0614: How can we help patients to make a treatment choice that fits them best? (Shared decision making)

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)40606-1 ◽

2015 ◽

Vol 115 ◽

pp. S297

Author(s):

J.J. Van Tol-Geerdink

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Treatment Choice ◽

Shared Decision

Download Full-text

Abstract P214: Patient and Physician Factors Influence Decision-Making in Hypercholesterolemia

Circulation ◽

10.1161/circ.131.suppl_1.p214 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Michel Krempf ◽

Ross J Simpson ◽

Dena R Ramey ◽

Philippe Brudi ◽

Hilde Giezek ◽

...

Keyword(s):

Decision Making ◽

Goal Attainment ◽

Clinical Decision Making ◽

Treatment Strategies ◽

Treatment Decision ◽

Clinical Decision ◽

Treatment Recommendations ◽

Treatment Choice ◽

Treatment Recommendation ◽

Double Blind

Objectives: Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We surveyed physicians’ treatment recommendations in high-risk patients with LDL-C not controlled on statin monotherapy. Methods: Physicians completed a questionnaire pre-randomization for each patient in a double-blind trial (NCT01154036) assessing LDL-C goal attainment rates with different treatment strategies. Patients had LDL-C ≥100 mg/dL after 5 weeks’ atorvastatin 10 mg/day and before randomization. Physicians were asked about treatment recommendations for three scenarios: (1) LDL-C near goal (100-105 mg/dL), (2) LDL-C far from goal (120 mg/dL), then (3) known baseline LDL-C of enrolled patients on atorvastatin 10 mg/day. Factors considered in their choice were specified. Physicians had been informed of projected LDL-C reductions for each treatment strategy in the trial. Regression analysis identified prognostic factors associated with each scenario, and projected LDL-C values for physicians’ treatment choices were compared to actual LDL-C values achieved in the trial. Results: Physicians at 296 sites completed questionnaires for 1535 patients. The most common treatment strategies for all three scenarios were: 1) not to change therapy, 2) double atorvastatin dose, 3) add ezetimibe, 4) double atorvastatin dose and add ezetimibe. Doubling atorvastatin dose was the most common treatment recommendation in all scenarios (43-52% of patients). ‘No change in therapy’ was recommended in 6.5% of patients when LDL-C was assumed far from goal. Treatment recommendations were more aggressive if actual LDL-C was known or considered far from goal. When compared with the ‘no change in therapy’ recommendation, CV risk factors and desire to achieve a more aggressive LDL-C goal were generally considered in decision-making for each treatment choice, regardless of LDL-C scenario. Patients randomized to a more aggressive regimen than recommended by physicians had larger reductions in LDL-C: the actual reduction in LDL-C in patients randomized to ‘add ezetimibe’ was -20.8% versus a projected reduction of -10.0% when physicians recommended ‘doubling atorvastatin dose’. Conclusions: This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. Targeting lower LDL-C and CV risk were key drivers in clinical decision-making but, generally, physicians were more conservative in their treatment choice than guidelines recommend, which may result in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose.

Download Full-text

Associations between patient knowledge of others' experiences and treatment choice in men with localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6578 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6578-6578

Author(s):

Aaron J. Katz ◽

Ying Cao ◽

Xinglei Shen ◽

Deborah Usinger ◽

Sarah Walden ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

North Carolina ◽

Cancer Patients ◽

Treatment Options ◽

Population Based ◽

Treatment Choice ◽

Localized Prostate Cancer ◽

The North ◽

Patient Reported

6578 Background: Men with localized prostate cancer must select from multiple treatment options, without one clear best choice. Consequently, personal factors, such as knowing other prostate cancer patients who have undergone treatment, may influence patient decision-making. However, associations between knowledge about others’ experiences and treatment decision-making among localized prostate cancer patients has not been well characterized. We used data from a population-based cohort of localized prostate cancer patients to examine whether patient-reported knowledge of others’ experiences is associated with treatment choice. Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of localized prostate cancer patients enrolled from 2011-2013 throughout the state of North Carolina in collaboration with the North Carolina Central Cancer Registry. All patients were enrolled prior to treatment and followed prospectively. Patient decision-making factors including knowledge of others’ experiences with prostate cancer treatment options were collected through patient report. Patient treatment choice was determined through medical record abstraction and cancer registry data. Results: Among 1,202 patients, 17% reported knowing someone who pursued active surveillance (AS) while 28%, 46%, and 59% reported knowing someone who received brachytherapy, external beam radiation (EBRT), or radical prostatectomy (RP), respectively; 26% underwent AS, 9% brachytherapy, 21% EBRT, and 39% RP as their initial treatment. In unadjusted analyses, patients with knowledge of others’ experiences with brachytherapy, EBRT or RP had more than twice the odds of receiving that treatment compared to patients who did not. Knowledge of others’ experience with AS was not associated with choice to undergo AS. Multivariable analysis adjusting for age, race, risk group, and patient-reported goals of care showed knowledge of others’ experiences with brachytherapy (OR 4.60, 95% confidence interval [CI] 2.76 to 7.68), EBRT (OR 2.38, 95% CI 1.69 to 3.34), or RP (OR 4.02, 95% CI 2.84 to 5.70) was significantly associated with odds of receiving that treatment. The odds of receiving a particular treatment option were further increased among patients who reported knowing someone who had a “good” experience with the treatment in question. Conclusions: This is the first population-based study to directly demonstrate the impact of a patient’s knowledge of others’ experiences on treatment choice in prostate cancer. These data provide a new consideration to clinicians in their counseling of patients with newly diagnosed prostate cancer, and also impacts research into the informed decision-making process for this disease.

Download Full-text