[Thrombosed popliteal aneurysm--a cause of acute lower leg ischemia]

Popliteal artery aneurysms (PAA) frequently remain asymptomatic up to the event of acute thromboembolic occlusion. Acute occlusions in the femoro-popliteal level without cardial source of embolism, a pulsating tumor in the knee pit or preexisting abdominal-or groin aneurysms are suspicious for the disease. Between 01/87 and 07/93 we saw 21 popliteal aneurysms in 14 patients. In 50% of the cases the aneurysms were found bilaterally. Arteriosclerosis was the most frequent cause, in 30% as a generalised dilative angiopathy. 18 aneurysms were operated upon, 11 in the stage of acute ischemia among a total of 190 acute vascular occlusions in the same period. Treatment consisted in total resection and anatomical reconstruction by means of saphenous vein interposition. The patency rate in our patients operated in the stage of acute ischemia was 73% during this observation period; one major amputation was carried out. The postoperative course of all 7 electively operated aneurysms was without complications. PAA is readily diagnosed by ultrasound. Because of the catastrophic consequences of an acute ischemia resulting from thrombosis we also tend to operate asymptomatic cases. For that reason the contra lateral knee of the healthy appearing leg should be included in the examination as well as higher located possible locations of dilatative angiopathy. A thrombotic treatment, PTA, stent implantation or embolectomy cannot be recommended because of remaining wall adhesive thrombi with danger of embolisation.