Small popliteal artery aneurysms: are they clinically significant?
OBJECTIVE
We undertook this study to determine whether popliteal artery aneurysm diameter correlates with initial symptoms and presence of associated occlusive disease.


METHODS
Duplex arteriography before infrainguinal revascularization in 500 lower extremities enabled diagnosis of 34 popliteal aneurysms in 25 patients (24 male, 1 female) over the last 4 years. Fourteen patients (41%) had no symptoms (group 1) and 20 (59%) had symptoms (group 2) of severe claudication (n = 8), acute ischemia (n = 6), rest pain (n = 2), and tissue loss (n = 4). We compared clinical presentation with popliteal artery diameter, prevalence of thrombosis, and presence of associated occlusive disease.


RESULTS
Popliteal artery aneurysm diameter averaged 2.8 +/- 0.7 cm (range, 1.8-4.5 cm) in group 1 and 2.2 +/- 0.8 cm (range, 1.3-4.0 cm) in group 2 (P <.03). Popliteal aneurysm thrombosis was present in 7 of 20 limbs in group 2. Four of these patients also had ipsilateral superficial femoral artery thrombosis. Evaluation of the infrapopliteal arteries in group 1 showed three-vessel runoff in 7 limbs, two-vessel runoff in 3 limbs, one-vessel runoff in 2 limbs, and no vessel runoff in 2 limbs. However, all infrapopliteal arteries were either occluded or significantly stenotic in 14 limbs (70%). In group 2, one-vessel runoff was observed in 5 limbs, and two-vessel runoff in 1 limb.


CONCLUSIONS
Smaller popliteal artery aneurysm was associated with higher incidence of thrombosis, clinical symptoms, and distal occlusive disease. Liberal use of duplex scanning in this setting may have accounted for the increased awareness that small popliteal artery aneurysms can thrombose and present with severe ischemia.
Ascher
Enrico
E
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA. eascher@maimonidesmed.org
Markevich
Natalia
N
Schutzer
Richard W
RW
Kallakuri
Sreedhar
S
Jacob
Theresa
T
Hingorani
Anil P
AP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019412:Anatomy, Cross-Sectional; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000453:epidemiology*; D018616:Ultrasonography, Doppler, Duplex