Aneurysms of the lower limbs: evaluation and management

In order to evaluate the results of the conservative follow up vs surgical management of infra-inguinal aneurysms, a retrospective review of 23 patients with 28 peripheral aneurysms of the lower limbs was undertaken. Among them, common femoral (5 cases) and popliteal (16 cases) aneurysms were most frequent; superficial femoral (1) and tibial (1) aneurysms were isolated; 5 patients had bilateral aneurysms. The majority of symptomatic aneurysms presented local discomfort (4), acute (4) or chronic (8) ischaemia. Symptoms of nerve (2) or view (1) compression were less common. Duplex or Color-Doppler Scanning, angio-TC and MR confirmed the clinical diagnosis; arteriography demonstrated the number of patent distal vessels. Nine arterial aneurysms were kept under clinical and ultrasonographic observation; three patients were submitted to delayed surgical repair; a major amputation was required and two of these died of cardiac diseases. In the remaining sixteen cases, early elective surgical repair was performed, with resection or ligation of aneurysms. Two cases of acute limb ischaemia were submitted to successful limb-salvage procedures. A primary amputation was necessary in a case with irreversible ischaemia; a lumbar sympathectomy was performed in a patient with a poor run-off. Dacron (5 cases), PTFE (5 cases) or autologous saphenous vein (11 cases) grafts were used. No post-operative complications or limb-loss occurred. Three patients died of myocardial infarction during the follow up period (mean 28 months). Authors' results suggest that early surgical repair of peripheral aneurysms of the lower limbs is the safest and most effective management.