Vascular 11

Abstract

The best management of patients with either thrombosed or nonthrombosed popliteal aneurysms has yet to be established. This paper describes our experience managing such aneurysms. A prospective study was carried out of all patients presenting with popliteal aneurysm (PA) during January 1988–December 2001. Since 1993, asymptomatic PA <3 cm in diameter without distortion were managed conservatively. Ultrasound scans were carried out at 6-monthly intervals. These results were compared with conservative management of popliteal aneurysms of >3 cm in diameter in patients who declined or were unfit for operation and with those patients who underwent elective bypass of PA. Results of patients presenting with thrombosed PA are also described. Fifty-eight patients (two women) presented with 92 PA. Some 39 had thrombosed PA and these patients were significantly more likely to have bilateral aneurysms (P < 0.001). Of the non-thrombosed PA managed conservatively none below 3 cm in diameter thrombosed. Patency of PA 2–3 cm in diameter was no worse than patency following elective bypass (P = 0.37). The risk of postoperative complications was greater with thrombosed compared with non-thrombosed PA (P < 0.005). Pre-operative lysis for thrombosed PA was associated with more complications than operation and on table lysis (P < 0.05). Careful monitoring of asymptomatic PA < 3 cm in diameter is safe. Pre-operative lysis is associated with increased risks compared with operation alone in those patients presenting with thrombosed PA.