Nonoperative management of selected popliteal aneurysms

In the management of 95 popliteal aneurysms, surgical therapy was initially successful in 90% of operations, while major limb amputation was required in 6%. Durability of surgical reconstruction was improved if autogenous saphenous vein was used and if the reconstruction was performed before development of complications. Twenty asymptomatic popliteal aneurysms were repaired without loss of limb and with a five-year secondary cumulative patency rate of 93%. Among 26 small asymptomatic popliteal aneurysms managed without operation, complications developed in only two (8%) during the period of observation. Because of the demonstrated safety and efficacy of surgical treatment, repair of popliteal aneurysms is recommended in acceptable operative candidates. However, there exists a subgroup of asymptomatic higher-risk patients with small popliteal aneurysms in whom a conservative nonoperative approach is reasonably safe.