[Popliteal aneurysms: comparison of the results of elective and emergent treatment]

The purpose of this study was to compare the outcomes of elective versus emergent operative repair of popliteal artery aneurysms. From 1988 to 2004, 108 popliteal aneurysms were repaired in 76 patients (mean age: 66 years; range: 42-86). Repair was elective in 70 cases - 19 asymptomatic (17%), 51 symptomatic (46%); and emergent in 38 cases; 12 of these with no identified outflow target vessel at initial arteriogram underwent intra-arterial thrombolysis. Proximal anastomosis was performed to the superficial femoral artery in 56 cases, to the popliteal artery in 24, to the common femoral artery in 28. Distal anastomosis was performed to the distal popliteal artery in 32 cases (29%) and to the infrapopliteal artery in 76 (70%). In the postoperative period, in the elective group one bypass was occluded and repaired, whereas in the emergent group 4 bypasses were occluded and amputated. During follow-up (mean duration: 57.8 months), in the elective group, 4 bypasses were revised, 5 occluded, and 2 amputated; in the emergent group, 5 bypasses were revised, and 3 were occluded and amputated. Primary patency was 98% and 79% in the elective group, as against 89% and 71% in the emergent group at 1 and 5 years, respectively. Limb salvage was 100% and 94% in the elective group, as against 89% and 81% in the emergent group at 1 and 5 years, respectively. The outcome is better with surgical treatment of elective popliteal aneurysms compared with emergency treated aneurysms. Aggressive reconstruction in patients with acute limb ischaemia is mandatory. Thrombolytic therapy may be useful in patients with no identified outflow target vessel.