[Popliteal aneurysm and leg ischemia: surgery first]

Area of Science:

• Vascular Surgery
• Aneurysm Treatment
• Ischemia Management

Background:

• Popliteal aneurysms are a significant cause of limb ischemia.
• The optimal treatment strategy for symptomatic popliteal aneurysms remains debated.
• Acute and sub-acute presentations require distinct management approaches.

Purpose of the Study:

• To evaluate the outcomes of different treatment modalities for symptomatic popliteal aneurysms.
• To compare surgical versus non-surgical interventions for sub-acute presentations.
• To assess the efficacy of treatments in preventing amputation and ensuring limb salvage.

Main Methods:

• Retrospective analysis of 90 popliteal aneurysms in 66 patients.
• Categorization of aneurysms into acute (27%) and sub-acute (45%) ischemia groups.
• Surgical treatment for all acute ischemia cases; varied treatments (bypass, sympathectomy, medical, fibrinolysis) for sub-acute cases.

Main Results:

• All 12 cases of acute ischemia were successfully treated with surgery, achieving limb salvage.
• In sub-acute ischemia, surgical bypass (7 cases) and sympathectomy (7 cases) were employed, alongside medical treatment (6 cases) and limited fibrinolysis (1 case).
• Overall, no peri-operative mortality and only one amputation (5%) were recorded, indicating effective management.

Conclusions:

• Surgery is the definitive treatment for acute ischemic popliteal aneurysms, ensuring limb salvage.
• Sub-acute popliteal aneurysms can be managed with various strategies, including surgical exclusion and sympathectomy, with favorable outcomes.
• The study highlights the effectiveness of surgical intervention in managing symptomatic popliteal aneurysms and preventing amputation.