Computed tomography for evaluation of arterial disease in the popliteal fossa

The clinical details, arteriograms, and computerized tomographic (CT) scans of 28 patients with popliteal arteriopathies were reviewed retrospectively to determine the usefulness of CT for the diagnosis and treatment of these disorders. Arteriography diagnosed 70% and CT diagnosed 98% of the 45 popliteal disorders. Popliteal aneurysms were not detected by arteriography because of occlusion in seven (20%) patients and intraaneurysmal thrombus that produced no luminal compromise in two. Thrombus was identified by CT in 22 of 24 patient aneurysms and suspected as the source of digital embolization in 7. Graft aneurysms were identified by CT in two cases, but one was not detected by arteriography because of graft occlusion. Two mycotic aneurysms were identified, one by arteriography and not by CT because of misinterpretation of a periarterial hematoma. Popliteal entrapment was diagnosed by CT in three cases, and in two cases occlusion precluded diagnosis of entrapment by arteriography. Adventitial cystic disease was diagnosed accurately by CT in three cases, and in two there were no characteristic arteriographic abnormalities. In cases of entrapment and cystic disease, the CT findings allow the surgeon to plan his approach through a posterior incision, which in these two instances facilitates surgical technique. CT provides detail of the arterial wall, intraarterial contents, and surrounding musculoskeletal anatomy, all of which are useful for accurate evaluation of arterial disorders of the popliteal fossa.