Results of Surgical Treatment for Popliteal Aneurysm

Abstract

Background: Evaluate the results of open surgery treatment of popliteal artery aneurysms (PAAs), performed in our department for over 25 years, comparing those treated with a medial approach with those treated with a posterior approach.

Material and method: A retrospective analysis of a total of 88 PAAs, performed between January 1994 and December 2018, with an average of 65 months follow-up, comparing the results of 59 patients operated by a medial approach (group 1) in which aneurysm exclusion and femoro-popliteal bypass below the knee was carried out, with 29 cases treated by a direct posterior approach (group 2) - aneurismectomy and graft interposition-. The postoperative complications, immediate and long term patency, limb salvage and mortality rate were studied.

Results: In group 1 the chosen material for the bypass was reversed greater saphenous vein (GSV) in 45 cases (76.3%), expanded polytetrafluoroethylene (ePTFE) grafts in 12 (20.3%) and Dacron grafts on 2 (3.4%), while in group 2, a 6 mm diameter ringed ePTFE graft was used in 27 cases (93.1%) and reversed GSV in 2 (6.9%). There were eight (13.6%) postoperative graft thrombosis in group 1, 5 (8.9%) of them needing amputation, and 1 (3.4%) graft thrombosis in group 2 (P = 0.077). During the follow up, major amputation was necessary in 2 cases (3.7%) in group 1, while there were no cases of major amputation in group 2. Mortality was 61% (36 patients) in group 1 and 27% (8 patients) in group 2 (p = 0.003), at the end of surveillance.

Conclusion: In our experience, in the open surgical treatment of PAAs, the posterior approach could be considered as the first choice in selected cases.