Popliteal artery aneurysms: Current management and outcome

Abstract

Thrombosis of popliteal artery aneurysms can produce limb-threatening ischemia. In this setting we have found preoperative thrombolytic therapy to be beneficial. Methods: Thirty-three patients with 54 popliteal artery aneurysms were studied (mean follow-up 62 months). Twenty-one patients (62%) had bilateral popliteal artery aneurysms, and 20 patients (61%) had extrapopliteal arterial aneurysms. Thirty-three (61 %) aneurysms had symptoms of compression or ischemia, and 21 (39%) aneurysms had thrombosis. A trend toward thrombosis for larger aneurysms was noted (p < 0.068). Results: Forty-five aneurysms were treated with bypass grafting. Five-year graft patency and limb salvage rates were 71% and 90%, respectively. Factors favoring graft patency and limb salvage included presence of two-or three-vessel runoff compared with patients with single-or no-vessel runoff (p < 0.025 graft patency;p < 0.003 limb salvage) and presence of a patent aneurysm (p < 0.005 graft patency and limb salvage). Seven patients diagnosed with thrombosis of their aneurysm and all runoff vessels were treated with preoperative thrombolytic therapy. Complete clearing of thrombus from these arteries was achieved in six of these patients (and from two of these runoff vessels in the remaining patient). These patients had better graft patency (p < 0.005) and limb salvage (p < 0.01) than comparable patients treated with emergency operations. Six amputations were performed in the follow-up interval, none of which were performed in patients having undergone thrombolytic therapy. Conclusions: It is concluded that popliteal aneurysms are managed best by elective repair of patent aneurysms with good runoff. In that difficult situation of the thrombosed popliteal artery aneurysm associated with acute leg ischemia, thrombolytic therapy safely and effectively provides patients with a more favorable alternative than emergency surgery.

Correção endovascular do aneurisma de artéria poplítea bilateral

“…A complicação mais comum associada aos aneurismas de artéria poplítea é o risco de trombose arterial aguda acompanhado de isquemia grave, com possibilidade de amputação do membro inferior acometido [10][11][12] . Microembolizações de repetição também podem causar progressivamente um quadro de isquemia crônica importante.…”

Long-term follow-up of surgically excluded popliteal artery aneurysms with multi-slice CT angiography and Doppler ultrasound

“…The risk of amputation varies between 24% and 69 % [2][3][4][5][6][7]. Moreover, untreated PAAs carry some risks of rupture or nerve compression, with potential limb dysfunction.…”

“…For these reasons, management of PAAs must be carefully carried out. Some authors [2,5,6,11,15,16,22] have shown that patency rates are better in elective cases, preventing distal embolization and a poor run-off [2,11,23,24]. Others risk factors justifying surgical approach are a diameter of more than 20 mm, a mural thrombus or a poor run-off, because they are predictive factors of acute thrombosis if not treated [12,23,24].…”

“…Popliteal artery aneurysms (PAAs) are the most frequent peripheral artery aneurysms [1] and are potentially dangerous lesions with high frequency of thromboembolic complications (18-77%) and amputation risk (10-67%) [2][3][4][5][6][7][8][9]. In cases of symptomatic PAAs, diameter exceeding 20 mm or presence of a mural thrombus [10][11][12], the procedure of choice is exclusion of the aneurysm and reverse saphenous vein bypass grafting.…”

Disseminated Intravascular Coagulation with Acutely-Thrombosed Popliteal Aneurysm

“…Regarding the five-year graft patency and limb salvage rates, patients with the presence of 2 or 3 runoff vessels had good results compared with single or no runoff vessel. 10) Thrombolytic therapy is useful to clear a thrombosed popliteal aneurysm and to open occluded infrapopliteal arteries. But thrombolysis can cause severe complications including major local bleeding or intracranial bleeding.…”