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OBJECTIVES: Popliteal artery aneurysms (PAAs) represent a challenging treatment paradigm with a variety of presentations and management options. The purpose of this study is to better delineate the management algorithm and to evaluate the outcomes of the current management guideline.
METHODS:A retrospective review was performed to identify all PAAs between Aug 2007 to Dec 2013.
RESULTS:74 limbs with PAAs in 61 patients (mean age 74.6±11, 98% male) were identified. 51 PAAs underwent repair, 27 by endovascular means (ENDO) and 24 repaired via open bypass graft (BPG). 23 PAAs were followed via routine duplex imaging (OBS) q6-12months for asymptomatic size <2.0cm. Average PAA size was 2.8cm±1.0 ENDO, 3.6±0.5 BPG, 2.0±0.6 OBS.
30% (9 patients) ENDO cohort had symptoms prior to repair, compared with 50% (12 patients) in BPG group. 4/27(15%) PAA in ENDO group presented with acute thrombosis and underwent thrombolysis followed by covered stent placement. In the BPG cohort, there was acute ischemia in 6, rest pain in 2, tissue loss in 1, and swelling in 1.
4 (17%) patients crossed over from OBS to treatment for aneurysm growth, 2 ENDO and 2 BPG (mean follow-up 14.6±10mo and 24mo, respectively and average increase growth 0.8cm across both groups).
Primary patency for ENDO and BPG was 93.3%±6.4 and 71.3±15.2 at 1yr, respectively. The 1/27 ENDO failure case was initially reintervened via endovascular means, however, eventually required a bypass. Of 3/24 BPG failure cases, 2 were successfully opened via endovascular means, and one required excision of the graft for infection. Secondary patency was 93% for both groups at 1yr. No limbs underwent major amputation.
CONCLUSIONS: The results suggest that the observation threshold of <2.0cm is safe in monitoring asymptomatic PAAs without any incidence of rupture. Further, even though surgical bypass was more commonly used for symptomatic and larger diameter PAAs, there are similar patency outcomes between the ENDO and BPG groups. Therefore, determination of ENDO vs BPG method should be as indicated by anatomic parameters such as landing zone, symptomatology such as the need for relieving mass effect, and specific adjunct need such as thrombolysis for either acute thrombosis or for distal target.