ATHEROSCLEROTIC POPLITEAL ANEURYSMS WITH PARTICULAR REGARD TO THE CONTRALATERAL SIDE

Abstract

A retrospective analysis of 75 patients with 103 atherosclerotic popliteal aneurysms, seen at princess alexandra hospital, brisbane, was undertaken to assess the results of management and the most appropriate approach to the contralateral popliteal aneurysm. These patients were seen between january 1968 and december 1985. There were no females, the mean age was 66.3 years and 36% of the patients had bilateral popliteal aneurysms. There was a high incidence of other associated aneurysms, abdominal aortic (21), femoral (12) and isolated iliac (3). Thrombosis in a popliteal aneurysm was the most common reason for presentation initially (48%), followed by detection of a lump in the popliteal fossa (22.6%), embolic phenomena (10.6%) and ruptured popliteal aneurysm (four cases). The most common presentation for contralateral aneurysms was detection of a lump in the popliteal fossa. Management of the contralateral popliteal aneurysm was classified as early, elective repair (n= 14) and no surgery or surgery delayed until the development of symptoms (n = 14). Outcome was classified as successful, retained and fully functional limb at follow-up; or failure, amputation or debilitating ischaemia. There was one failure among those undergoing early elective repair and seven failures among those undergoing no or delayed surgery (p = 0.033, fisher's enact test). There were 79 reconstructions. Bypass and ligation (n = 54) resulted in two amputation and two long-term occlusions, interposition augmented vein graft (n= 15) in two amputations and no long-term occlusions and interposition dacron grafts (n= 10) with no amputations and three long-term occlusions. Early elective repair of the contralateral popliteal aneurysm, using autogenous tissue is recommended, preferably using the bypass and ligation technique. Careful investigation for synchronous aneurysmal disease and follow-up for metachronous aneurysmal disease should be instituted in these patients.