Popliteal Aneurysm

Incidence

50% symptomatic (thrombosis, embolism, compression, rupture)
Pts present with acute (20%) or chronic (15%) limb ischaemia secondary to aneurysm thrombosis or distal emboli
Rupture is rare
Often have had long hx of microemboli resulting in significant downstream damage – thus, often poor run-off vessels
Symptoms may be transient
Clinically: Easily palpable popliteal pulse

Duplex USS/ CT
Angio: May not demonstrate the aneurysm well due to mural thrombus reducing lumen diameter

In acute ischaemia
- Emergency popliteal аnеսrysm repair
- intra-arterial thrombolysis
  - If absent or limited distal runoff
  - Restoration of outflow improves the long-term patency of revascularization
  - Τhrοmbоlytiϲ agents can be administered intraoperatively or using catheter-based techniques
    - Can prepare pt for surgery or be done when immediate surgery is not imperative (i.e. light touch intact) – good to clear run-off vessels in-order to bypass graft
Indications for surgical reconstruction (ligation and vein bypass)
- 2cm
- Presence of laminar thrombus
- If symptomatic with peripheral embolization
Approach
- Posterior approach with inlay autologous graft is most preferred
- Bypass graft and tie off often results in ongoing flow into aneurysm and dilation of aneurysm
- Endovascular repair is a viable option now given flexible endografts for symptomatic pts in the elective setting – though may have risk of disruption of thrombus and downstream emboli

High complication rates (60%) if left untreated
Majority will become symptomatic within 1-3yrs if left untreated
Pts who develop acute ischaemia have a relatively poor prognosis (15% amputation rate)
5yr graft patency rates after surgical repair for asymptomatic pts ≈ 80%