Aneurysms of the Extremity

Over 80 percent of all peripheral arterial aneurysms arise in the popliteal artery and the vast majority are due to atherosclerosis. More than 95 percent of patients with popliteal aneurysms are elderly males.13 Acute symptoms develop with thrombosis or distal embolization and rupture is rare.

False aneurysms of the femoral artery, consisting of encapsulated hematomas adjoining the vessel lumen, arise from iatrogenic injury and occur more frequently than true femoral aneurysms. Duplex ultrasonography, CT scan, or an MRI can confirm the clinical diagnosis and detect mural thrombus. The risk of ischemic complications from an asymptomatic popliteal aneurysm ranges from 8 to 100 percent (mean 36 percent). Thus, elective surgery following arteriography is recommended for all cases.13 As 37 percent of patients with a single popliteal aneurysm have an aortic aneurysm and half have a contralateral popliteal aneurysm, a thorough search is indicated after detection of a single aneurysm.

Subclavian artery aneurysms occur from atherosclerosis, trauma, or thoracic outlet obstruction. Rupture of a proximal subclavian aneurysm can cause death from exsanguination. Thromboembolism gives rise to typical signs and symptoms of distal ischemia, but it may also produce central neurologic deficits from retrograde propagation of clot into the vertebral and carotid circulation. Because of their severe potential morbidity, these aneurysms should be surgically removed promptly after diagnosis.

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