Popliteal artery aneurysms from a vascular surgeon's point of view

Abstract

Popliteal artery aneurysms (PAA) are a dangerous complication of general atherosclerosis or other diseases. PAAs with a diameter of less than 2 cm are observed despite the fact that small aneurysms may also result in peripheral embolism. The spectrum of complications in the course of the disease ranges from multiple embolism into the crural arteries or complete thrombosis of the popliteal artery associated with complete ischaemia. Rupture is rare even in large aneurysms. Interventional therapy using covered stents does not lead to results comparable with surgery and is not considered as standard therapy. Surgical technique in asymptomatic aneurysms includes resection/exclusion of the PAA with reversed vein PI-PIII vein bypass. In case of acute ischaemia the therapy has to be modified according to anatomic aspects and has to be combined in some cases with intraoperative lysis. Amputation rate may be as high as 40%. Large aneurysms (>3 cm) should be treated by aneurysmorrhaphy or resection with graft interposition rather than simple bypass. In our study with short follow-up only 3 of 10 patients were asymptomatic. Survival rate, limb salvage and patency amounted to 100%.