Popliteal Aneurysm Repair

Excerpt

Popliteal artery aneurysms are the most common aneurysms of the peripheral artery, with 7/100,000 in men and 1/100,000 in women incidence. They are true aneurysms, and their pathogenesis is related to the mechanical degradation of the tunica media by immune cells and the anatomic location of the popliteal artery at a high flexion point behind the knee. The popliteal artery is aneurysmal if the vessel is 1.5 times the diameter of a normal adjacent segment of the artery. Of patients with this pathology, 50% have bilateral popliteal artery aneurysms, and 30 to 40% of these patients have concomitant abdominal aortic aneurysms.

The growth rate of these aneurysms increases linearly as their diameter increases, and hypertension is the primary risk factor for increased growth. Rupture is rare with these aneurysms, whereas distal ischemia from thrombosis or embolization is the most common cause of morbidity and results in a very high limb loss rate. Diagnosis can be made by physical examination with a prominent popliteal pulse and mass. Imaging, including duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, or standard angiography, is useful in diagnosing these aneurysms.