Surgical treatment of popliteal artery aneurysm. A 20 year experience

A retrospective study to evaluate the treatment, long term follow-up and factors affecting revascularization results particularly in regard to clinical presentation and prosthetic materials used after 20 years of experience.

Between 1974 and September 1995 there were 67 popliteal aneurysms in 58 patients. Three patients underwent a primary amputation because of irreversible ischaemia and 3 patients a surgical sympathectomy. Operative repair was performed in 61 cases: as an emergency in 9 (14.7%) limbs and as an elective procedure in 52 (85.3%) limbs. Graft replacement was performed employing polytetrafluoroethylene (PTFE) grafts in 34 (55.7%) cases 13 of which with Ringed PTFE, autogenous saphenous vein in 10 (16.4%) cases and Dacron in 17 (27.9%).

The cumulative primary patency (CP) and limb salvage rate (LS) at 10 years were 75.1% and 83.3% respectively. We divided the patients into two groups: asymptomatic (Group I) and symptomatic with limb threatening ischemia (Group II). At 10 years the CP in Group I and II were 78.2% vs 67.2% respectively (p < 0.05 at 18 months) and the LS 87.4% vs 74.6% (p < 0.05). There was no statistical difference in terms of CP and LS rate between saphenous vein and PTFE. The use of PTFE grafts avoided harvesting of the long saphenous vein; this resulted in a significantly reduced operation time (135 +/- 18.6 vs 195 +/- 22.4 minutes, p < 0.001) and length of stay (7.4 vs 8.8 days, p < 0.02).

We conclude that elective repair is indicated in all patients with popliteal aneurysm > or = 2 cm to avoid a critical ischemia with poorer results in terms of CP and LS. In the last 3 years our technique of choice is the exclusion of the aneurysm with a short PTFE bypass with good long-term of CP and LS rates.