Atherosclerotic popliteal aneurysm

Abstract

Background: A popliteal artery aneurysm (PAA) has been described as a 'sinister harbinger of sudden catastrophe'. This review seeks to provide data regarding the epidemiological aspects, natural history, clinical presentation and results of treatment to help clinicians make appropriate decisions.

Methods: A systematic review of data in the English language literature published since 1980.

Results: The authors include 29 studies containing 1673 patients with 2445 PAAs. No controlled trials exist regarding the management of PAAs.

Conclusion: (1) At most, only four or five patients are seen each year by a major vascular centre; (2) aortic aneurysms are found in 37 per cent and bilateral PAAs in 50 per cent of patients; (3) more than 95 per cent of patients are men with a mean age of 65 years and 45 per cent have hypertension; (4) approximately one-third of patients are asymptomatic at the time of initial diagnosis; (5) the risk of ischaemic complications after conservative follow-up varies from 8 to 100 per cent (mean 36 per cent), depending on the selection of patients and duration of follow-up; (6) elective surgical reconstruction is recommended for all asymptomatic aneurysms; (7) 5-year graft patency rates after surgical repair range from 29 to 100 per cent, with 5-year limb salvage ranging from 75 to 98 per cent; (8) patient survival rates at 5 and 10 years are 70 and 44 per cent respectively; (9) lifelong, careful patient surveillance is essential to detect and treat new aneurysms at other sites.