[Controversies regarding an algorithm and the type of surgical treatment in popliteal aneurysms]

Having outlined their 20-year experience in the treatment of popliteal aneurysms (PA), the authors discuss the type of therapeutic approach used. From the authors' point of view an overly aggressive approach to PA is unnecessary, and the decision to adopt a given therapy must instead be weighed up on the basis of the careful clinical evaluation of each individual case, taking into account the patient's clinical conditions at the time, the pathological anatomy of the lesion and its consequences. The authors divide primary PA into symptomatic and asymptomatic cases; in the latter surgery is definitely indicated and the possible contraindications represented by anesthesiological risk or small aneurysm diameter need not be evaluated. In the case of symptomatic PA, treatment varies depending on whether they are manifested by rupture, acute ischemia or chronic ischemia. While there are no grounds for uncertainty regarding the need for immediate surgery in the first case, in the second and third cases the authors attribute decisive importance to the evaluation and possible improvement of run-off before surgical correction. In the event of acute arterial insufficiency of the limb, the careful assessment of clinical conditions (degree of loss of sensitivity, motility and cutaneous vascularization) and anamnestic data (possible presence of signs and symptoms of previous chronic arterial insufficiency) allow the surgeon to decide whether or not to resort to immediate surgery or to obtain an improved run-off by using loco-regional fibrinolytic therapy and therefore postpone surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)