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

Objective: Popliteal artery aneurysms (PAA) are most frequent among peripheral aneurysms. The most commonly performed surgical repair is proximal and distal ligation with a saphenous vein bypass. We aim to report the early and mid-term outcome of surgical repair of popliteal artery aneurysms via a posterior approach. Methods: A retrospective review of consecutive patients who underwent surgical PAA repair in two vascular surgery units between 1998 and 2009 was performed. Within this group, the posterior approach was used in 28 repairs in 26 patients (25 men). All patients had an ultrasound examination. Eighteen patients underwent conventional angiography while CT angiography with 3-D reconstruction was used from 2003 to evaluate an endovascular option. Primary and secondary graft patency, limb salvage and patient survival rates were determined using Kaplan–Meier methods. Results: All aneurysms did not involve the superficial femoral artery and the popliteal trifurcation. Interposition grafting was performed with a great saphenous vein in 19 repairs while a 6.0-mm–8.0-mm PTFE graft in the remaining nine. The 30-day primary patency rate was 100%. The average popliteal aneurysm diameter was 3.8 cm (range, 2.1–6.4). Three aneurysms were thrombosed at the time of surgery, and two of these presented as acute limb ischemia. Eight patients had chronic symptoms, claudication was present in five and ischemic rest pain in three. The remaining patients were asymptomatic or with mild discomfort. An S-shaped curvilinear incision was preferred in all repairs and no problems with postoperative healing or wound infection were observed. The average length of stay was 4.6 days. Four patients were lost to follow-up. One-year primary graft patency, secondary graft 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 posterior approach is associated with excellent mid-term durability. Moreover, the posterior approach facilitates the resection of aneurysm, avoids continued aneurysm expansion from communicating branches and reduces wound complications frequently seen after femoro-popliteal bypass.