Popliteal aneurysms, personal experience

Background. The 70% of peripheral aneurysms are localized at the popliteal artery; approximately one third of patients are asymptomatic, but the occurrence of complications (acute ischemia, rupture) endangers the survival of the leg. The purpose of this paper is to demonstre the validity of elective surgery for popliteal aneurysms, also for asymptomatic lesions. Methods. Twenty-seven popliteal aneurysms were observed in 20 patients; only 7 of these were affected by a unilateral lesion, other 7 patients by a bilateral lesion and the remainder 6 patients by a polydistrict association; 3 patients refused the surgical therapy which was proposed. Prosthetic grafting with exclusion or resection of the aneurysm has been practiced in 16 cases; one time only a Dacron graft was employed, while the autologous saphenous vein was employed in 15 cases. A locoregional thrombolysis has been performed in 3 patients, in presence of an acute peripheral ischemia. In 5 cases a conservative approach has been chosen; these were asymptomatic aneurysms with a <2 cm diameter. Results. In 87,5% of patients operated (14/16) a good immediate result was obtained. In a mean 2 years follow-up the 75% of these patients mantained the clinical result. The fibrinolytic therapy was resolutive in 2 cases of acute peripheral ischemia; a lumbar sympathectomy was necessary in one case. Conclusions. In consideration of the complications that the aneurysmatic disease can give, among which the acute peripheral ischemia is the most dreadful, a surgical approach is widely justified, also in the light of the good results described.