A multicenter study of popliteal aneurysms. Joint Vascular Research Group

The purpose of this study was to determine current practice in the treatment of all categories of popliteal aneurysms (PA) in light of the efficacy of intraarterial thrombolysis in PA presenting as acute ischemia.

Prospective data collected from 19 vascular surgeons from 200 PA in 137 patients during a 4-year period from 1989.

The most common presentation (125 PA) was leg ischemia, with the most severe symptom being claudication in 58, acute limb-threatening ischemia in 56, and digital atheroembolism in 11 limbs. The nonischemic group (75 PA) included 43 symptom-free cases and 32 cases with local symptoms arising from the popliteal fossa. Of 62 patients requiring emergency treatment, bypasses were done in 56, 10 of whom had early occlusion. Thrombolysis was used alone or in combination with bypass on 23 occasions, with 16 successful outcomes. Of 138 PA presenting electively, 80 underwent bypass, with one early occlusion, and 58 were observed. In the observed group, 18 later underwent bypass during a median follow-up of 22 months. The indications for late bypass were expansion of a small (< 2 cm) asymptomatic PA and the development of distal ischemia. There were 18 deaths in the observed group because of medical unfitness; limb ischemia did not develop during follow-up.

Intraarterial thrombolysis is of value in restoring the distal run off before bypass in PA presenting as acute limb-threatening ischemia. However, the results do not justify an expectant policy for asymptomatic aneurysms.