VS15P VEIN GRAFT AND DELAYED EMBOLISATION FOR THE MANAGEMENT OF POPLITEAL ARTERY ANEURYSM

Abstract

Purpose: To present an alternative method for surgical management of symptomatic popliteal artery aneurysm. This is particularly applicable to very long aneurysms. It is a very good method to avoid recurrent aneurysm formation. Methodology: In 2005 a 73 year old man presented with embolism to the right foot from a popliteal artery aneurysm. He had a proximal and distal ligation coupled with vein by-pass for a left popliteal artery aneurysm in 2000. Further surgery, by posterior approach with over sewing for recurrent aneurysm was undertaken in 2003. This right PAA extended from one cm below the bifurcation of the common femoral artery to the knee joint line. In view of the excessive length of the aneurysm, in order to avoid the recurrence of aneurysm and ischemia for extensive ligation a vein bypass graft was carried out and ligation of the aneurysm distally. But no ligation was carried out proximally. Three months later the patient had embolisation of the feeding arteries under local anaesthesia, in a controlled manner in theatre observing the circulation of the leg. After three years of follow up there is no recurrence. Result: The patient experienced a very good result. This management is now the authors’ preferred manner of treatment. This procedure is a unique example of managing PAA with very encouraging outcome. Conclusion: 1 An alternative method for management of Popliteal Artery Aneurysm is offered. 2 It reduces the initial operating time and it reduces the extent of surgery. 3 It also reduces the chance of recurrence with minimal complications. 4 Modern surgical management of A.V. Malformation Follows same principles.