Evolving Treatment of Popliteal Artery Aneurysm

Abstract

During the past decade, the treatment of popliteal aneurysms has evolved at our institution from the sole operative intervention during the initial part of the study period, to combined surgical and endovascular treatment, and finally, to endovascular-centered management in more recent years. Outcomes among treatment modalities for popliteal aneurysms were assessed. This is a retrospective review of all patients with popliteal aneurysms treated at our institution from 2001 to 2011. Data collection included the indication for intervention, treatment details, interventional patency, limb salvage, perioperative outcome, and long-term survival. During this period, 88 aneurysms were treated in 72 patients. Indications for intervention included 47 (53%) with symptomatic presentations, and 41 (47%) were asymptomatic. Treatment included endovascular exclusion in 24, surgical repair in 63 (14 posterior approach and 49 medial approach with bypass and exclusion), and primary amputation in one patient. Nine aneurysms (10.2%) received catheter-directed thrombolysis (Fig). Demographics were similar between the two treatment cohorts, except for age, with endovascular stenting patients significantly older (76.0 vs 66.0 years, P = .002). The mean length of stay was 3.9 vs 9.5 days (P < .001), favoring endovascular treatment. There were no perioperative (30-day) deaths in the endovascular group and one death in the surgical cohort. The mean patency follow-up was 18.5 vs 28.3 months. Primary patency did not differ between endovascular and surgically treated patients at 1 year (92.3% vs 83.3%, P = .26) and 3 years (61.5% vs 77.8%, P = .89). No limbs were lost in the endovascular group during the follow-up period of 22.4 months. One late limb loss occurred in the surgical cohort (mean follow-up, 29.2 months). The long-term survival rate was 65% in the endovascular patients (mean follow up, 33.9 months) and 80.8% in the surgical patients (mean follow up, 42.9 months, P = .22). Endovascular treatment of popliteal aneurysms provides similar short-term patency to that of the traditional gold standard approach with surgical bypass, with shorter hospitalizations in symptomatic and asymptomatic patients. Further long-term follow-up is required to compare these two treatment modalities for durability to determine the optimal popliteal aneurysm management.