Popliteal aneurysm: a review of 116 cases

Abstract

One hundred and sixteen cases of popliteal aneurysm have been studied. The condition most commonly represents a local manifestation of generalized degenerative arterial disease, either occlusive or dilating. In the latter instance the condition is more often bilateral and there is a higher incidence of aortic aneurysm. Symptoms occur from complications irrespective of the size of the aneurysm. The results of reconstructive operations in false aneurysrns are bad, and unless there is good cause to consider that some form of reconstruction would be successful a lumbar sympathectomy is probably the best treatment. Operation should be advised in all cases with a paten; aneurysm and in those with a thrombosed aneurysm and patent tibia1 vessels. In cases with tibial vessel obstruction due to embolism, clearance can often be effected by the use of an embolectomy catheter to allow distal anastomosis. When a popliteal aneurysm is a manifestation of generalized dilating disease the results of surgery are excellent and long lasting, but if there is generalized stenosing disease the results are the same as after operation for diffuse atherosclerosis. In patients with bilateral popliteal aneurysms, one of which is complicated, the uncomplicated one should probably be operated upon first, although sometimes both may be done at the same session. Sympathectomy seems a worth‐while operation in patients in whom no distal vessel is available for anastomosis, and other proximal reconstructions may be indicated, particularly when diffuse stenosing disease is present.

Problems in Diagnosis of Popliteal Aneurysms

“…The popliteal artery is the most common site for aneurysm formation after the abdominal aorta (Linton 1949, Bouhoutsos & Martin 1974, but many popliteal aneurysms are asymptomatic and their true prevalence is unknown. They occur almost exclusively in men with generalized atherosclerosis, many of whom have aneurysmal disease of other major arteries (Linton 1949, Gifford et al 1953, Wychulis et al 1970.…”

Colour Doppler sonography of limb arteries

“…Unlike those involving the abdominal aorta, popliteal aneurysms are prone to thrombose and to lead to episodes of peripheral embolization (up to 69 % of the cases) (Fig. 19) [81,82,83]. Embolic events can arise massively and cause acute limb ischaemia or can occur chronically leading to progressive impairment of runoff.…”

Embolization from a fusiform middle cerebral artery aneurysm.

“…Thirdly, the intraluminal and extraluminal pressure exerted on the aneurysm is probably fairly constant. Aneurysms of either the extracranial carotid artery or the popliteal artery, 24 for example, would be subject to the local pressure generated by contraction of adjacent muscles. This might increase extraluminal and consequently intraluminal pressure and tend to dislodge unorganized or partially organized thrombus.…”