THE CONTINUING CHALLENGE OF ANEURYSMS OF THE POPLITEAL ARTERY

This report is an analysis of 252 popliteal artery aneurysms (PAA) in 167 patients treated surgically at die University Hospital in Zurich d uring a 27 year period from 1965 to 1991. The predominance of male pat ients (95 percent) was consistent with that of other reports. PAA were bilateral in 51 percent of the patients and were associated with aneu rysms at other sites in 38 percent. Atherosclerosis was by far the mos t common cause (98 percent). PAA were symptomatic in 75 percent of the patients, the predominant findings being ischemia from emboli, thromb osis or rupture. Primary amputation was required in 23 extremities. Su rgical reconstruction with bypass was performed for 229 PAA. A seconda ry amputation was necessary in 18 limbs. The risk of complications fro m popliteal aneurysm, and the good results from surgical treatment sug gest that a revascularization procedure in the asymptomatic stage shou ld be recommended unless specific contraindications exist. We conclude that surgical treatment should be performed in symptomatic and asympt omatic PAA larger than 2 centimeters in diameter. Long term results of surgical reconstruction are improved if an autogenous saphenous vein is used and if reconstruction is performed before the occurrence of co mplications. Poly-tetrafluoroethylene prostheses should be used when a n autologous saphenous vein is not available. The use of Dacron(R) (po lyester fiber) grafts is no longer indicated.