Surgical and endovascular treatment of atherosclerotic popliteal artery aneurysms.

Popliteal artery aneurysms are the most common peripheral aneurysms. Patients with unrecognized aneurysms may present with acute limb ischemia and considerable threat for limb loss due to thromboembolic complications. This article reviews short-term and long-term results of surgical and endovascular treatment for mainly elective repair of popliteal artery aneurysms. A systemic review was conducted of data in the English literature from 1990. The review included 1 prospective randomized trial, 6 prospective studies, and 42 retrospective studies on the management of popliteal artery aneurysms. These studies contained 2 197 patients with 2 882 popliteal artery aneurysms. Short-term results are acceptable, with average 1-year patency rates of 90% for surgical treatment and 75% for endovascular treatment, and respective limb salvages rates of 95% and 100%. Endovascular treatment lacks long-term follow-up, whereas venous surgical repair has an average 5-year patency rate of up to 85% (prosthetic grafts, 40-80%). There is a need for randomized trials comparing long-term results of surgical versus endovascular treatment of popliteal artery aneurysms. So far, long-term results of elective surgical repair for popliteal artery aneurysms are acceptable if venous grafts are used. In any case, acute repair of popliteal artery aneurysms must be avoided.