Popliteal artery aneurysms. Thirty-year experience at the ABC Medical Center

Guillermo Alfonso Rojas-Reyna; Jorge Cervantes-Castro; Raúl Alvarado-Bachmann; Ricardo Wellman-Wollenstein; Andrés Cervera-Servín

2008, Number 1

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Cir Cir 2008; 76 (1)

Popliteal artery aneurysms. Thirty-year experience at the ABC Medical Center

Rojas-Reyna GA, Cervantes-Castro J, Alvarado-Bachmann R, Wellman-Wollenstein R, Cervera-Servín A

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Language: Spanish
References: 31
Page: 55-59
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ABSTRACT

Backgound: Although popliteal artery aneurysms (PAA) are rare (0.1 % of the general population), they are the most common of the peripheral aneurysms. They are associated with concomitant contralateral PAA and abdominal aortic aneurysm.
Methods: We performed a retrospective, transversal and retrolective study of a series of cases. We reviewed the clinical records of 11 patients with the diagnosis of PAA at the ABC Medical Center in Mexico City.
Results: All patients were males, and seven (63.63 %) had bilateral PAA resulting in a total of 18 aneurysms; 54.54 % had concomitant aneurismas de la aorta abdominal with an association of 71.42 % in the cases of bilateral PAA. Primary risk factors were smoking (90.90 %) and hypertension 63.60 %. Six (33.33 %) aneurysms demonstrated acute thrombosis and critical leg ischemia. Eight (44.44 %) aneurysms treated electively had a favorable outcome. The six (33.33 %) thrombosed aneurysms showed morbidity, amputation and mortality rates of 66.66, 33.33 and 16.66 %, respectively. For the other four (22.22 %) aneurysms, treatment was deferred. Specific analysis of the thrombosed PAA demonstrated that the two main factors that predicted thrombosis were hypertension (p = 0.029) and bilaterality.
Conclusions: In view of the high morbidity and mortality rates of thrombosed PAA, it is advisable to perform elective surgical treatment in any popliteal aneurysm › 2 cm and with the presence of mural thrombus, torsion and, especially, if it is bilateral and the patient is hypertensive.

REFERENCES

1. Ticket JP, Scout RAP, Tilney HS. Screening and management of asymptomatic popliteal aneurysms. J Med Screen 2002;9:92-93.
2. Henke PK. Popliteal artery aneurysms: tried, true and new approaches to therapy. Semin Vasc Surg 2005;18:224-230.
3. Varga ZA, Locke-Edmunds JC, Baird RN. A multicenter study of popliteal aneurysms. J Vasc Surg 1994;20:171-177.
4. Galland RB. Popliteal aneurysm. In: Parvin SD. Earnshaw JJ, eds. Rare Vascular Disorders: A Practical Guide for the Vascular Specialist. Shrewsbury, UK: TFM Publishing Ltd;2005. pp. 263-270.
5. Szilagyi DE, Schwartz RL, Reddy DJ. Popliteal artery aneurysms. Their natural history and management. Arch Surg 1981;116:724-728.
6. Jacob T, Ascher E, Hingorani A. Initial steps in the unifying theory of the pathogenesis of artery aneurysms. J Surg Res 2001;101:37-43.
7. Jacob T, Schutzer R, Hingorani A. Differential expression of YAMA/CPP-32 by T lymphocytes in popliteal artery aneurysm. J Surg Res 2003;112:111-116.
8. Loftus IM, McCarthy MJ, Lloyd A. Prevalence of true vein graft aneurysms: implications for aneurysm pathogenesis. J Vasc Surg 1999;29:403-408.
9. Davis M, Cheshire NJW. No popliteal aneurysm is safe to leave. In: Greenhalgh RM, ed. More Vascular and Endovascular Controversies. London: BIBA Medical Ltd;2006. pp. 307-312.
10. Graham LM. Femoral and Popliteal Aneurysms. Philadelphia, Lippincott Williams & Wilkins;2001.
11. Nicholson T. Imaging of popliteal artery aneurysms. In: Greenhalgh RM, ed. Towards Vascular and Endovascular Consensus. London: BIBA Medical Ltd;2005. pp. 527-532.
12. Loftus IM, Thompson MM. Endovascular popliteal aneurysm repair will become the gold standard. Against the motion. In: Greenhalgh RM, ed. More Vascular and Endovascular Controversies. London: BIBA Medical Ltd;2006. pp. 329-334.
13. Galland RB. Popliteal aneurysm. Controversies in their management. Am J Surg 2005;190:314-318.
14. Verhoeven ELG. Tielliu IFJ, Kapma MR, Zeebregts CJ. Popliteal artery aneurysms: endovascular options. In: Greenhalgh RM, ed. Towards Vascular and Endovascular Consensus. London: BIBA Medical Ltd;2005. pp. 538-546.
15. Gifford RW, Hines EZ, Janes JM. An analysis and follow-up study of one hundred popliteal aneurysms. Surgery 1953;33:284-293.
16. Michaels JA, Galland RB. Management of asymptomatic popliteal aneurysms: the use of a Markov decision tree to determine the criteria for a conservative approach. Eur J Vasc Surg 1993;7:136-143.
17. White GH, Mohan IV, Bray PJ. Bray AE, May J, Harris J. Endovascular popliteal aneurysm repair will become the gold standard. For the motion. In: Greenhalgh RM, ed. More Vascular and Endovascular Controversies. London: BIBA Medical Ltd;2006. pp. 314-328.
18. Goyanes J. Nuevos trabajos de cirugía vascular, sustitución plástica de las venas o arterioplastia venosa, aplicada como nuevo método de tratamiento de los aneurismas. Siglo Med 1906;53:546-561.
19. Pringle JH. Two cases of vein grafting for the maintenance of a direct arterial circulation. Lancet 1913;1:1795-1796.
20. Hollier LH, Stantson AW, Gloviczki P, et al. Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease. Surgery 1983;93:700-708.
21. Green R. Popliteal aneurysms: vascular options. In: Greenhalgh RM, ed. Towards Vascular and Endovascular Consensus. London: BIBA Medical Publishing;2005. pp. 527-532.
22. Ramesh S, Michaels JA, Galland RB. Popliteal aneurysm: morphology and management. Br J Surg 1993;80:1531-1533.
23. Pittathankal AA, Dattani R, Magee TR. Expansion rates of asymptomatic popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2004;27:382-384.
24. Biasi GM, Froio A, Piglionica M, Deleo G. No popliteal aneurysm is safe to leave for the motion. In: Greenhalgh RM. More Vascular and Endovascular Controversies. London: BIBA Medical Ltd;2006. pp. 299-306.
25. Aulivola B, Hamdan A, Hile C, et al. Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair. J Vasc Surg 2004;39:1171-1177.
26. Blanco E, Serrano FJ, Moñux G, Vega M, et al. Operative repair of popliteal aneurysms: effect of factors related to the bypass procedure on outcome. Ann Vasc Surg 2004;18:86-92.
27. Martin ML, Veith FJ, Panetta TF. Transfemoral endoluminal stented graft repair of a popliteal artery aneurysm. J Vasc Surg 1994;19:754-757.
28. Rodríguez TJ, Rodríguez LJ. Curn ES, Escobar CG. Manejo endovascular para aneurisma poplíteo. Rev Mex Angiol 2000;28:103-110.
29. Gerasimidis T, Sfyroeras G, Papazoglou K, et al. Endovascular treatment of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2003;26:506-511.
30. Lagana D, Mangini M, Marras M, et al. Percutaneous treatment of femoro-popliiteal aneurysms with covered stents: Radiol Med (Torino) 2002;104:322-331.
31. Laxdal E, Amundsen SR, Dregelid E, et al. Surgical treatment of popliteal artery aneurysms. Scand J Surg 2004;93:57-60.