Surgical and endovascular treatment of popliteal artery aneurysms: single centre experience

Aim. Popliteal aneurysms (PAs) are the most frequent peripheral artery aneurysms and those of more than 2 cm in diameter are considered candidates for elective surgery. Although the standard treatment of popliteal artery aneurysms has been open repair, there are increasing reports in the literature of endovascular management, which allows a quicker recovery and a shorter hospital stay. In this study results after either open or endovascular treatments are assessed. Methods. Between January 2004 and January 2009, 21 PAs were treated in 21 patients: short and mid-term outcomes have been retrospectively evaluated. Results. Six patients (28.6%) presented bilateral PAs. Mean age was 73 years (range 46-95 years). One patient was female. Mean diameter of PAs was 3.7 cm (range 1.6-9.5 cm). Two (9.1%) aneurysms were asymptomatic. Seven (33.3%) patients presented claudicatio intermittens, and thirteen (61.9%) patients acute ischemia of lower limbs (ALI). Fifteen (68.2%) patients, thirteen with ALI and two with severe claudicatio intermittens, underwent intra-arterial thrombolytic therapy. Eleven (50%) patients were operated on, six (54.5%) through medial approach, in one patient an ePTFE graft was implanted for an unsuitable saphenous vein. Nine (40.9%) patients underwent endovascular aneurismal exclusion. Five patients presented an asymptomatic PA, controlateral to the treated one, with mean diameter of 1.32 cm (range: 1.2-1.5 cm, dev St: 0.13). All these small and asymptomatic PAs were not treated. A 57 years old patient presented ALI due to complete thrombosis of a PA with diameter of 1.6 cm and he successful underwent intra-arterial thrombolytic therapy followed by oral anticoagulants, without any further treatment. The mean follow-up of surgical treated patients was 37 months, and the mean follow-up of endovascular-approached patients was 15 months. Three surgically treated patients, suffering ALI and an extremely poor distal run-off, underwent early amputation (30-days). In surgically treated patients primary and secondary patency rates were respectively 62.5% (5/8 patients) and 87.5% (7/8 patients). After endovascular exclusion primary and secondary patency rates were 60% (6/9+1, hybrid, patients) and 100%. Conclusion. Endovascular exclusion of PAs appears to allow short and mid-term results similar to those of surgical treatment. However, favorable results associated with endovascular treatment options come at a cost of diminished durability and potentially increased need for reintervention, further forcing tighter postprocedural follow-up.