Popliteal artery aneurysms: tried, true, and new approaches to therapy

Popliteal artery aneurysms are the most common peripheral aneurysm. They are associated with concomitant contralateral popliteal aneurysms and abdominal aortic aneurysms. Patients with unrecognized aneurysms may present with acute limb ischemia and potential for limb loss. Use of preoperative lytic therapy to improve distal runoff prior to exclusion and bypass has significantly improved the outcome from acute thrombosis. Long-term follow-up has shown that both proximal and distal ligation of the aneurysm are important because a thrombosed aneurysm may begin to enlarge after a long period of quiescence. Popliteal aneurysms are now being treated with covered stents. This article delineates the current evaluation, preoperative planning, and surgical and endovascular approaches to this disease. With proper diagnosis and repair, excellent limb salvage and postoperative function has become the norm.