THE POSTERIOR APPROACH IN THE REPAIR OF POPLITEAL ARTERYANEURYSMS: A TWO CENTER EXPERIENCE

Objective: Popliteal artery aneurysms (PAA) are most frequent amongperipheral aneurysms. The most commonly performed surgical repair isproximal and distal ligation with a saphenous vein bypass. We aim to reportthe early and mid-term outcome of surgical repair of popliteal artery aneurysmsvia a posterior approach.Methods: A retrospective review of consecutive patients who underwentsurgical PAA repair in two vascular surgery units between 1998 and 2009was performed. Within this group, the posterior approach was used in 28repairs in 26 patients (25 men). All patients had an ultrasound examination.Eighteen patients underwent conventional angiography while CT angiographywith 3-D reconstruction was used from 2003 to evaluate an endovascularoption. Primary and secondary graft patency, limb salvage and patient survivalrates were determined using Kaplan–Meier methods.Results: All aneurysms did not involve the superficial femoral artery andthe popliteal trifurcation. Interposition grafting was performed with a greatsaphenous vein in 19 repairs while a 6.0-mm–8.0-mm PTFE graft in theremaining nine. The 30-day primary patency rate was 100%. The averagepopliteal aneurysm diameter was 3.8 cm (range, 2.1–6.4). Three aneurysmswere thrombosed at the time of surgery, and two of these presented as acute limb ischemia. Eight patients had chronic symptoms, claudication waspresent in five and ischemic rest pain in three. The remaining patients wereasymptomatic or with mild discomfort. An S-shaped curvilinear incision waspreferred in all repairs and no problems with postoperative healing or woundinfection were observed. The average length of stay was 4.6 days. Fourpatients were lost to follow-up. One-year primary graft patency, secondarygraft patency, limb salvage and patient survival rates were 92.8%, 96.4%,96.4% and 100%, respectively.Conclusions: These data demonstrate that surgical PAA repair through a posteriorapproach is associated with excellent mid-term durability. Moreover,the posterior approach facilitates the resection of aneurysm, avoids continuedaneurysm expansion from communicating branches and reduces woundcomplications frequently seen after femoro-popliteal bypass.