Popliteal artery aneurysms: the risk of nonoperative management

To evaluate the risk of nonoperative management of popliteal artery aneurysms (PAAs), a retrospective cohort study of 106 consecutive patients (103 males and 3 females) with PAAs seen between January 1, 1980, and December 31, 1985, was performed. The mean age was 70.5 years (range 50 to 90 years). The 106 patients with 161 PAAs were followed for a mean of 6.7 years (range 3 days to 12.1 years). Follow-up was complete in 91.5% (97/106) of the patients. PAA was confirmed by ultrasonography in 124 limbs (77%), arteriography only in 7 (4.3%), and physical examination only in 32 (19.9%). Fifteen limbs presented with acute symptoms, 52 with chronic symptoms, and 94 were asymptomatic. Five of the 15 limbs with acute symptoms (33%) underwent amputation (4 primary, 1 secondary). PAAs in 23 of the 52 limbs with chronic symptoms were repaired; 2 limbs required amputation (8.7%). Twenty-seven of the 94 asymptomatic limbs were repaired initially; 1 required amputation (3.7%). The remaining 67 asymptomatic limbs were initially managed nonoperatively. Amputation was required in 3 of 67 limbs (4.4%), 1 with acute symptoms and 2 with chronic symptoms, all of which had undergone attempted repair. Symptoms (3 acute, 9 chronic) eventually developed in 12 (17.9%). At least one of three risk factors (size > 2 cm, thrombus, and poor runoff) was initially present in 11 of 12 limbs (91.7%) compared with 9 of 24 control limbs (37.5%) that remained asymptomatic (p < 0.05). Amputation rates in symptomatic patients with PAAs continues to be high. In patients with asymptomatic PAAs, aneurysm size > 2 cm, thrombus, or poor runoff predicted the development of symptoms. PAA patients with any of these factors should undergo elective repair, even asymptomatic patients who have a reasonable chance for long-term survival.