Popliteal aneurysm: diagnostic workup and results of surgical treatment

Untreated popliteal aneurysm (PA) may cause serious complications. Early detection and surgery are beneficial. What are the circumstances under which the diagnosis of PA is made? What risks are associated with the treatment? A total of 36 consecutive PAs in 22 men and 2 women were treated in a single-center series. Altogether, 26 surgical reconstructions (group 1) were performed using a medial approach, and two PAs were resected through a dorsal approach. Eight patients with eight PAs did not undergo surgery (group 2): Two were awaiting surgery, and six had refused it. At the time of diagnosis, 25 PAs were symptomatic: local pain, swelling, or "pulsation" in the popliteal groove (29%); claudication of the foot/calf (39%); critical ischemia (21%). Eleven asymptomatic cases were discovered during screening duplex sonography of known aortic aneurysms. Among the 28 PAs that underwent surgery, 6 produced acute symptoms. The following complications were observed: five postoperative hematomas, one infected polytetrafluoroethylene (PTFE) graft, two early graft occlusions, and two significant stenoses of the distal anastomosis. After a mean follow-up of 15 months (range 2-43 months), group 1 had a limb salvage rate of 100% and a secondary patency rate of 96%. Two patients are still awaiting surgery. Critical ischemia represents an absolute indication for surgical repair, but the observed zero mortality and relatively low morbidity associated with the intervention combined with a favorable patency rate justify the liberal use of surgery even for asymptomatic PAs. The extensible medial approach is preferred. Sequential reconstruction is advised for bilateral PAs.