Arteries of the Lower Limb—Embryology, Variations, and Clinical Significance

Objectives: The purpose of this article is to review the embryology of the lower limb arterial anatomy along with common variants and their clinical relevance. Design: Embryologic variations of the lower limb arterial system may be explained by i.) persistence of primordial arterial segments, ii.) abnormal fusion, iii.) segmental hypoplasia/absence, or a combination of both. Persistent sciatic artery, corona mortis, and popliteal entrapment syndrome will also be discussed with associated symptoms, and potential complications. Conclusion: Knowledge of these variations is essential for surgical and endovascular management as failure to recognize them can result in complications.

Popliteal entrapment syndrome—The case for a new classification

Objectives To assess the ability of the current classification system for popliteal entrapment syndrome to accurately capture all patients, and if not, to design an all-inclusive new classification. Methods Retrospective review of all interventions performed for popliteal entrapment syndrome between 1994 and 2013 at our institution was performed. Preoperative imaging and intraoperative findings were used to establish the compressive morphology of popliteal entrapment syndrome. Patients were categorized, when possible, into six types of the current classification system (Rich classification, modified by Levien) and into seven types of a new classification. Results Sixty-seven limbs of 49 patients were operated on for unilateral (31) or bilateral (18) popliteal entrapment syndrome. The current classification system captured the anatomy of only 43 (64%) of 67 limbs with popliteal entrapment syndrome. Compressive morphologies without a defined class included aberrant insertion of the lateral head of gastrocnemius muscle, muscle slip originating from the lateral head of gastrocnemius or hamstrings, hypertrophied hamstring muscle, abnormal fibrous bands, perivascular connective tissue, and prominent lateral femoral condyle. The new classification captured 100% of the limbs with popliteal entrapment syndrome. Conclusions Current classification of popliteal entrapment syndrome is inadequate as more than one-third of the cases reviewed fell outside of the standard classification system. Consideration of a more inclusive new anatomic classification system is warranted.

Thrombosis of popliteal artery aneurysm with cutaneous microembolism of toes

Popliteal artery aneurysms (PAAs) are rare, and usually affect men over 60 years of age with established cardiovascular disease due to atherosclerosis. They can also be congenital or can occur due to trauma, mycotic aneurysm, popliteal entrapment or inflammatory arteritis. This is a case of a 95 year old male, with history of recent subdural hematoma, who presented with acute onset right lower limb pain and edema. He was found to have right PAA with thrombosis which was throwing cutaneous microemboli to the toes. He underwent open aneurysm repair with Dacron graft and thrombectomy and improved.