[Does a type  II endoleak occur after surgical elimination of a popliteal artery aneurysm? An Analysis of 42  patients and a comparison with current literature].
In a clinical follow-up of our therapeutic results for popliteal artery repair, there were 2  recurrences. Angiomorphologically the results could be classified as an endoleak type  II form.


METHODS
In a retrospective analysis of 56  popliteal artery aneurysms in our vascular surgery department between September 2000 and 2010, 47  cases underwent surgical and 9  cases endovascular repair. The average age of the patients was 70.2  years (49-88  years); males were in the majority (92.8 %) in comparison to females (7.2 %). In the ambulatory follow-up, 2  patients that had had surgery showed an increase in size of the operated popliteal artery. Duplex sonography, angio-CT scan and selective angiography were used to verify the results.


RESULTS
47  cases were treated with surgical repair. In 42  cases a proximal and distal surgical exclusion with ligation of the aneurysm was performed via a medial approach. In 5  cases a dorsal approach was used for the aneurysmectomy. In the post-operative follow-up period 2  surgically repaired popliteal aneurysms showed persistent reperfusion. In both these cases the medial approach was chosen, leaving the aneurysm in situ. The reperfusion was proved with the help of an angio-CT scan. A selective DSA (Doppler sonography) confirmed the results. Both recurring aneurysms were re-operated firstly due to the increase in size and secondly due to the diagnosis of an imminent rupture.


CONCLUSIONS
The retrospective analysis showed that in the follow-up 2 (3,6 %) primarily repaired popliteal aneurysms had a recurrence with an increase in size. They were both repaired via a medial approach. In both cases the recirculation was diagnosed via the geniculate vessels. According to the endoleak classification of endovascularly repaired aortic aneurysms, the diagnosis is equivalent to an endoleak type  II classification. [nl]The ligation alone, without the occlusion of the geniculate branches, lead to a persistent back flow and reperfusion with increase in size of the aneurysms. The therapeutic option of such recurrences, due to the presence of active genicular recirculation ought to be the occlusion of these vessels that supply the aneurysm. The safest method to prevent such recurrences is without doubt the extirpation, the aneurysmo-endorraphy as well as the proximal and distal ligation, that definitely occludes the genicular vessels. As a rule the duplex sonography examination is advisable to control repaired popliteal aneurysms in situ.
DRK Kliniken Berlin-Köpenick, Klinik für vaskuläre und endovaskuläre Chirurgie, Berlin, Deutschland. m.naundorf@drk-kliniken-berlin.de
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Naundorf
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D000792:Angiography; D017130:Angioplasty; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex