title: Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair.
abstract: OBJECTIVE
  The purpose of this study was to assess and compare outcomes of elective versus emergent operative repair of popliteal artery aneurysms.
  
  
  METHODS
  A retrospective analysis of a prospectively recorded vascular surgery database from June 1992 to December 2002 was performed with chart review. Main outcome measures Patient survival, limb salvage, and graft patency were evaluated.
  
  
  RESULTS
  Fifty-one popliteal artery aneurysms were repaired in 39 patients, all male and ranging in age from 18 to 87 years (mean 67.1). Mean follow-up was 47.8 months. Repair was elective in 37 (72.5%) and emergent in 14 (27.5%) limbs, 13 with acute ischemia and one with aneurysm rupture. Thrombolytic therapy was utilized in four ischemic limbs with no suitable bypass target vessel identified on initial arteriogram. Outflow vessels included the popliteal artery in 22 (43.1%) and infrapopliteal vessels in 29 (56.9%) limbs. Cardiac morbidity and 30-day mortality rates were 0%. Overall primary patency, secondary patency, limb salvage, and actuarial survival were 95.6%, 100%, 98.0%, and 98.0% at 1 year and 85.1%, 96.9%, 98.0%, and 83.8% at 5 years, respectively. Bypass graft redo or revision was performed for stenosis in one and occlusion in four limbs. Two amputations were performed at 6 days and 63.6 months after initial aneurysm repair. No difference was noted between elective and emergent groups with regard to patency, limb salvage, or survival (P >.26), and no association between the number of identified target vessels and limb salvage or patency was demonstrated (P =.12).
  
  
  CONCLUSIONS
  In our experience, the outcome of the popliteal artery aneurysm repair was comparable in the emergent and elective settings. Aggressive tibial reconstruction plays a crucial role in the treatment of popliteal artery aneurysms, especially in those presenting with acute limb ischemia. Thrombolytic therapy is infrequently required in the acute setting, although it may be useful in patients with no identifiable outflow target vessel on initial arteriogram.
authors.affiliation: Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5B, Boston, MA 02215, USA. baulivol@caregroup.harvard.edu
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aulivola
authors.forename: Allen D
authors.initials: AD
authors.lastname: Hamdan
authors.forename: Chantel N
authors.initials: CN
authors.lastname: Hile
authors.forename: Malachi G
authors.initials: MG
authors.lastname: Sheahan
authors.forename: John J
authors.initials: JJ
authors.lastname: Skillman
authors.forename: David R
authors.initials: DR
authors.lastname: Campbell
authors.forename: Sherry D
authors.initials: SD
authors.lastname: Scovell
authors.forename: Frank W
authors.initials: FW
authors.lastname: LoGerfo
authors.forename: Frank B
authors.initials: FB
authors.lastname: Pomposelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D001900:Boston; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005121:Extremities / Q000098:blood supply* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency / Q000502:physiology