Surgical Outcomes of Popliteal Artery Aneurysm, Resection vs. Exclusion

Ryo Kanamoto, Shinichi Hiromatsu, Shinichi Imai, Yusuke Shintani, Shinichi Nata, Kazuyoshi Takagi, Hiroyuki Otsuka, Satoru Tobinaga, Seiji Onitsuka, Koichi Arinaga, Hiroyuki Tanaka

Department of Surgery, Kurume University School of Medicine, Kurume-city, Fukuoka, Japan

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–B

Abstract

Objects: Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm and causes lower limb ischemia.We usually perform either surgical reconstruction with resection of the aneurysm, or bypass surgery with exclusion of aneurysm for PAA patients. We aimed to compare the clinical outcomes of these surgical procedures for PAA.

Methods: We reviewed 18 limbs from 13 patients (11 males, 2 females, mean age 71.2 years) whounderwentsurgery for PAA between January 2002 and September 2017.The patients were divided into two groups; theresection group (11 limbs) comprised those who were treated by surgical reconstruction with resection of the aneurysm, and the exclusion group (7 limbs) included those who received bypass surgerywithexclusion of aneurysm.We retrospectively compared clinical outcomes between the two groups.

Results: The etiology for PAA was arteriosclerosis in 12 patients and Behçet’s disease in one patient. In the exclusion group, 42.9% of the patients required reoperation for aneurysmectomy because of expansion of the remaining aneurysm. There were no statistically significant differences between the two groups in 5-year patency rate according to theKaplan-Meier estimates (resection group vs. exclusion group, 90.9% vs. 85.7%, log-rank; P = 0.773).Regardingvascular events (reoperation and bypass occlusion)the5-year vascular event-free rate using theKaplan-Meier estimates was 90.9% in the resection group and 53.6% in the exclusion group (log-rank; P = 0.043). During the study period, there were no cases of lower limb amputation in either group.

Conclusions: Our study suggested that resection of aneurysm should be the first choice in surgical treatment of PAA whenever possible. However, since resection of the aneurysm may be difficult in emergent cases of acute limb ischemia, we should pay very careful attention to the possibility of vascular events in PAA patients treated by bypass surgery with exclusion of aneurysm.