PROGRESSION OF POPLITEAL ANEURYSMAL DISEASE FOLLOWING POPLITEAL ANEURYSM RESECTION WITH GRAFT - 20 YEAR EXPERIENCE

Abstract

Multifocal occurrence of peripheral atherosclerotic aneurysms is well known. Little attention was directed to subsequent progressive aneurysmal development adjacent to sites of previously resected and grafted popliteal aneurysms. During a 20 yr follow-up study of 79 patients with 115 popliteal aneurysms, the development of 6 atherosclerotic femoropopliteal aneurysms adjacent to the original aneurysm site was observed in 4 patients, occurring 5 mo. to 10 yr (average 5 1/2 yr) after the initial operation. Operative repair was accomplished successfully of 5 of the 6 aneurysms; 1 popliteal aneurysm was not yet operated upon. In the entire group there were 36 patients with bilateral popliteal aneurysm (46%). Fifty-seven patients (72%) presented with complications of the aneurysm, including 35 with thrombosis. As initial therapy, 69 grafting procedures were performed on 58 patients; 9 extremities had sympathectomy only; 4 aneurysms were ligated or resected without grafting and 4 extremities required amputation as the only procedure. Among patients with grafts, 9 subsequent amputations were necessary in the early postoperative period, all occurring in patients presenting with thrombosed aneurysms. No patient who developed pedal pulses in the period immediately after operation required amputation. Two patients developed aneurysmal degeneration in popliteal homografts. These data demonstrate the progressive nature of popliteal aneurysmal disease and emphasize the need for regular and life-long follow-up.