Surgical Treatment of Asymptomatic Popliteal Aneurysms Using Midline Posterior Incision

Abstract

The authors report eight cases of surgical treatment of popliteal aneuryms via a strictly posterior approach. The aneurysm was asymptomatic in each case and was diagnosed during assessment of a symptomatic contralateral popliteal aneurysm treated by a conventional technique (exclusion—interposition of a femoropopliteal vein graft or prosthetic tube via a medial incision). The operation was performed with the patient in the ventral supine position and consisted of excision graft with direct anatomical interposition of a femoropopliteal prosthetic tube. This approach has limitations as it cannot be extended superiorly and is therefore indicated in saccular or short fusiform aneurysms whose superior pole does not extend beyond Hunter's canal. In all eight cases, the prosthesis consisted of a 8 mm PTFE spiral tube. All patients underwent postoperative bilateral dynamic angiography and all were asymptomatic. During the same period, four postoperative thromboses of the grafts requiring embolectomy were observed in four cases of conventional repair of symptomatic contralateral aneurysms. The use of the posterior approach for popliteal aneurysm surgery, considering very precise criteria, appears to be a very attractive alternative, decreasing the morbidity, restoring a strictly anatomical course, and allowing a reduction in the incidence of the graft's thrombosis, ensuring a better long-term patency.