Does infrapopliteal arterial runoff predict success for popliteal artery aneurysmorrhaphy?
BACKGROUND
A 6-year experience with surgical management of popliteal artery aneurysms (PAAs) was examined to determine the influence of infrapopliteal outflow vessel patency on the long-term success of popliteal artery aneurysmorrhaphy.


METHODS
Arteriograms were reviewed to characterize the anatomy of the infrapopliteal arterial runoff. Regular clinical evaluation and prospective serial duplex scan surveillance assessed graft patency.


RESULTS
A total of 28 patients underwent 45 popliteal aneurysmorrhaphies. Elective repair was performed in 32 limbs (71%); emergency treatment was needed for 13 limbs (29%) because of acute limb-threatening ischemia. All patients were managed with PAA exclusion and reversed saphenous vein grafting. Only 20 limbs (44%) had a patent trifurcation with three continuous vessels to the ankle, 13 (29%) had two continuous tibial vessels, 10 (22%) had one patent runoff artery, and 2 (4%) had no vessel continuous to the foot. With a mean follow-up of 19.1 months, the 5-year primary graft patency by life-table analysis was 95 +/- 12.3%, with a 5-year assisted primary patency of 97 +/- 10.0%. One vein graft underwent elective secondary revision. Another graft thrombosed, requiring a secondary bypass. Outcome did not correlate with the status of the runoff anatomy. Limb salvage was 100%.


CONCLUSIONS
The use of autologous reversed vein grafting and attention to technical details yielded normal graft hemodynamics and excellent long-term patency and limb salvage despite the suboptimal runoff anatomy associated with PAAs.
Vascular Surgery Section, Uniformed Services University of the Health Sciences, Wilford Hall Medical Center, Lackland AFB, Texas.
R T
RT
Hagino
R M
RM
Fujitani
D L
DL
Dawson
D L
DL
Cull
J L
JL
Buehrer
S M
SM
Taylor
J L
JL
Mills
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology* / Q000601:surgery*; D012074:Remission Induction; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency