Follow-Up of the Aneurysmal Sac After Exclusion and Bypass of Popliteal Artery Aneurysms

Abstract

Popliteal artery aneurysms are frequent and may lead to thromboembolic events and limb loss. PURPOSE: To evaluate clinical and ultrasonographic follow-up of patients who underwent exclusion of a popliteal artery aneurysm using the technique proposed by Edwards. METHODS: Data of all patients who underwent surgery to repair a popliteal artery aneurysm at Hospital das Clinicas, the São Paulo University Medical School between 1996 and 2004 were reviewed. Inclusion criteria were repair with aneurysm exclusion and bypass using the technique proposed by Edwards, as well as the existence of preoperative and postoperative measurements of the aneurysmal sac. RESULTS: Data of 16 patients who underwent 20 procedures for popliteal artery aneurysm exclusion and bypass were available to analysis. The preoperative diameter of the popliteal artery aneurysms ranged from 1.3 cm to 6.1 cm (mean = 3.1 cm). Patients underwent duplex ultrasound scanning 1 month to 7 years after surgical repair. Follow-up of the 20 cases revealed that 10 aneurysms exhibited decreased mean transverse diameters, ranging from 0.2 to 2.3 cm, while 7 had increased in diameter, ranging 0.3 to 3.3 cm, and 3 remained unchanged. Flow was observed only in 5 outo f the 20 procedures, 3 of which (60%) had increased diameters. CONCLUSION: Although exclusion is a widely accepted procedure for the repair of popliteal artery aneurysms, data in the literature and the results of this study, which did not include cases of rupture or compression, suggest that strict follow-up of patients who undergo aneurysm exclusion is necessary.

The medial versus the posterior approach in the repair of popliteal artery aneurysms: A multicenter case-matched study

“…This might lead to mechanical complications and sometimes even rupture. [13][14][15][16][17][18] To overcome this problem, some surgeons use the extended medial approach. By working around the medial head of the gastrocnemius muscle, direct exclusion of the PAA will be possible.…”

“…1,[7][8][9][10][11][12] This technique does not, however, exclude side branches with their origin in the PAA, which can be responsible for retrograde perfusion in the ligated aneurysm sac and eventually lead to aneurysm enlargement and worse, rupture. [13][14][15][16][17][18] Direct exclusion from an extended medial incision is technically possible, with transection of the sartorius, gracilis, semimembranosus, and semitendinosus tendons. The only structure in the way is the medial head of the gastrocnemius muscle, which might be rather easy to work around.…”

Comparative Study between Medial and Posterior Approaches in Management of Popliteal Artery Aneurysm

“…The patency rates in saphenous graft was 85 % versus 65% for PTFE graft (p < .01). The graft material affects the primary and secondary patency rates according to many studies 17,18,7 .…”

Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP

“…These rates are the reason why careful monitoring of patients who have undergone popliteal aneurysm repair is necessary, whether treated with endovascular or open surgery. 42 In our review, there was just one case of acute thrombosis of a stent, in which a bypass was performed to save the limb. Retreatment was necessary in 10% of the endovascular cases, compared with the open group, in which 14.28% needed additional intervention within 30 days.…”