Nationwide study of the outcome of popliteal artery aneurysms treated surgically

Background: The aim was to study the epidemiology and outcomes of popliteal artery aneurysm (PA) treated surgically. Methods: Among 110000 procedures registered prospectively in the Swedish Vascular Registry (Swedvasc), there were 717 primary operations for PA among 571 patients. Patient records were reviewed and data validated against other registries. Results: The median age of the patients was 71 years; 5.8 per cent were women. Among 264 legs treated urgently, 235 had acute ischemia and 24 had rupture. Of patients with unilateral PA, 28.1 per cent had an aortic aneurysm, 8.4 per cent an iliac aneurysm and 9.4 per cent a femoral aneurysm. Extra-popliteal aneurysms were more common when the PAs were bilateral (P = 0.004). The rate of limb loss within I year of operation was 8.8 per cent; 12.0 per cent for symptomatic and 1.8 per cent for asymptomatic limbs (P < 0.001). Risk factors for amputation were symptomatic disease, poor run-off, urgent treatment, age over 70 years, prosthetic graft and no preoperative thrombolysis when the ischaemia was acute. Amputation rates decreased over time (P = 0.003). Crude survival was 91.4 per cent at I year and 70.0 per cent at 5 years. Conclusion: Multiple aneurysm disease was common when PAs were bilateral. Preoperative thrombolysis of acute thrombosis and the use of vein grafts for bypass improved outcome.