DOES INFRAPOPLITEAL ARTERIAL RUNOFF PREDICT SUCCESS FOR POPLITEAL ARTERY ANEURYSMORRHAPHY

BACKGROUND: A 6-year experience with surgical management of popliteal artery aneurysms (PAAs) tvas examined to determine the influence of in frapopliteal outflow vessel patency on the long-term success of poplit eal artery aneurysmorrhaphy. METHODS: Arteriograms were reviewed to ch aracterize the anatomy of the infrapopliteal arterial runoff. Regular clinical evaluation and prospective serial duplex scan surveillance as sessed graft patency. RESULTS: A total of 28 patients underwent 45 pop liteal aneurysmorrhaphies. Elective repair was performed in 32 limbs ( 71%); emergency treatment was needed for 13 limbs (29%) because of acu te limb-threatening ischemia. All patients were managed with PAA exclu sion and reversed saphenous vein grafting. Only 20 limbs (44%) had a p atent trifurcation with three continuous vessels to the ankle, 13 (29% ) had two continuous tibial vessels, 10 (22%) had one patent runoff ar tery, and 2 (4%) had no vessel continuous to the foot. With a mean fol low-up of 19.1 months, the 5-year primary graft patency by life-table analysis was 95 +/- 12.3%, with a 5-year assisted primary patency of 9 7 +/- 10.0%. One vein graft underwent elective secondary revision. Ano ther graft thrombosed, requiring a secondary bypass Outcome did not co rrelate with the status of the runoff anatomy. Limb salvage was 100%. CONCLUSION: The use of autologous reversed vein grafting and attention to technical details yielded normal graft hemodynamics and excellent long-term patency and limb salvage despite the suboptimal runoff anato my associated with PAAs.