Surgical repair of popliteal artery aneurysms remains a safe treatment option in the endovascular era: a 10-year single-center study

Introduction: Endovascular popliteal artery aneurysm repair has emerged recently as a feasible alternative to standard surgical repair. However the evidence from the literature is still limited, with only case reports, case series and one small randomized trial. Currently these data suggest the use of stent-grafts in patients at very high surgical risk. The purpose of this study is to present our surgical experience in popliteal artery aneurysm repair in an era of endovascular philosophy. Materials and Methods: Data from 36 consecutive patients who were admitted to our hospital from January 2000 to April 2010, were analyzed retrospectively. Twenty-six patients underwent surgical treatment through medial or posterior access. The posterior approach was used preferentially. The medial access was adopted in case of aneurysm involving the superficial femoral artery or for large aneurysm. Results: Twelve patients (Group A; 46,1%) were operated on via medial access followed by femoro-popliteal bypass. In the remaining fourteen patients (Group B; 53,9%) an interposition graft through posterior approach was performed. Thirthy-day over all mortality was 3,8% (1/26). Thirthy-day amputation rate was 0% in both groups. Primary patency rate was 83,3% in Group A at medium follow-up of 78,8 months (range 18-128 months) and was 100% in Group B at medium follow-up of 46,3 months (range 5-121 months). Conclusion: Notwithstanding the large use of stent-graft worldwide, surgical repair remains the gold standard for popliteal artery aneurysm management. In our experience this procedure is associated with low mortality and morbidity rate, either through medial or posterior access.