Rt. Hagino et al., DOES INFRAPOPLITEAL ARTERIAL RUNOFF PREDICT SUCCESS FOR POPLITEAL ARTERY ANEURYSMORRHAPHY, The American journal of surgery, 168(6), 1994, pp. 652-658
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.