Abstract
Objectives: Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm. PAA has low mortality and high amputation rate in the patient. We analyzed the medical records of PAAs experienced at our departments to clarify operative strategy. Methods: The medical records of PAAs were retrospectively reviewed in Yamanashi University Hospital (1992–2011) and Tokyo Medical University Hachioji Medical Center (2005–2011). Results: PAAs were diagnosed in 29 legs in 21 patients (male 17, female 4, mean 73.6 years). Average size of PAAs was 33.9 mm (13–70). Twenty three PAAs (79.3%) were treated surgically (bypass 20, direct anastmosis 1, below-knee amputation 2). Average follow-up time after operation was 1364 days. Saphenous vein grafts (SVGs) in 10 legs and prothetic grafts in 10 legs were used in bypass surgery. The cumulative estimated 5-year patency of all grafts was 71.8%. Emergency operations were performed in 12 legs with symptomatic PAAs (bypass 11). The amputations were performed in 2 patients with small PAAs (15, 30 mm). The 5-year patency of elective and emergency operations were 100% and 44.3% (p=0.03). The 5-year patency of medial approach with SVG, with prosthetic graft, and posterior approach with prosthetic graft were 88.9%, 45.7%, and 100%, respectively. One patient in the medial approach group needed re-operation for re-expanded PAA from back flow. The 5-year patency of using SVG, prosthetic graft (≥8 mm), prosthetic graft (<8 mm) were 87.5%, 100%, and 31.3%, respectively. Conclusions: Our data demonstrated that the elective surgical treatment should be performed in patients of asymptomatic PAA. There is no difference between both approaches in the patency. The posterior approach might be more effective to avoid re-operation. The patency of prosthetic graft (≥8 mm) would be as good as SVG in surgical bypass of PAA.
