Management of popliteal artery aneurysms

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Medical Research

Background:

• Popliteal artery aneurysms (PAA) are the most common peripheral aneurysms, often termed 'the silent killer of the leg circulation'.
• The optimal timing and type of PAA interventions remain subjects of ongoing debate.
• This review synthesizes current knowledge on PAA natural history, epidemiology, clinical presentation, and management.

Purpose of the Study:

• To review published data on popliteal artery aneurysms (PAA).
• To examine the natural history, epidemiology, and clinical presentation of PAA.
• To evaluate current management options and establish a consensus on the best treatment strategies for PAA.

Main Methods:

• A systematic review of English-language publications since 1980.
• Inclusion of 53 studies comprising 2854 patients and 4291 PAA.
• Analysis of predominantly retrospective studies and personal experiences, noting the absence of randomized controlled trials.

Main Results:

• PAA are primarily atherosclerotic in older men but linked to trauma, infection, or family history in younger individuals.
• Diagnosis requires vigilance, with many patients asymptomatic (45%) and often presenting with concomitant aortic aneurysms (40%) or bilateral PAA (50%).
• Surgical reconstruction for aneurysms >2 cm yields 5-year graft patency (30-97%) and limb salvage (70-98%) rates, with 5- and 10-year survival at 75% and 46% respectively.

Conclusions:

• Surgical repair is recommended for symptomatic and asymptomatic PAA exceeding 2 cm.
• Intra-arterial thrombolysis can facilitate surgical revascularization for acute ischemia.
• Endovascular repair is a feasible option, though evidence is limited; lifelong surveillance for new aneurysms is crucial.