Complications and treatment of popliteal aneurysms

Because arteriosclerotic popliteal aneurysms so often present with complications, treatment results are less than optimal in contrast to aneurysms oat other sites. From 1963 to 1977, 40 surgically treated aneurysms in 30 patients were studied. Seventeen limbs presented as asymptomatic aneurysms (42.5%), four with pressure symptoms (10%), one with rupture and ischemia (2.5%), nine with acute thromboses and ischemia (22.5%), and nine with chronic ischemia and claudication (22.5%). Seventeen aneurysms were thrombosed (42.5%). Diameters of all aneurysms measured at operation ranged from 1.0 to 10 cm. It was of interest to note that, generally, larger aneurysms were patent, and thromboses were common in the smaller aneurysms, with an average diameter of 2.5 cm. Saphenous vein grafts were used most frequently for interpolation grafts (65%) and bypass grafts (12.5(). Prosthesis were used in 7.5%, endarterectomy and aneurysmorraphy in 5%. Popliteal reconstruction was accomplished initially in 40 limbs, with two early failures and 10 late failures with loss of two limbs. Cumulative patency rates for 40 limbs at risk at 5 and 10 years were 75.9%, at 14 years, 62.6%. Diagnosis is the most difficult aspect of this problem, as physical limitations impede early diagnosis. Thromboses being the natural history of popliteal aneurysms, early recognition and treatment are important to improve limb salvage rates.