Popliteal artery aneurysms: Current management and outcome Jeffrey P. Carpenter, MD, Clyde F. Barker, MD, Brooke Roberts, MD, Henry D. Berkowitz, MD, Edward J. Lusk, PhD, Leonard J. Perloff, MD  Journal of Vascular Surgery  Volume 19, Issue 1, Pages 65-73 (January 1994) DOI: 10.1016/S0741-5214(94)70121-0 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Arteriographic findings in 39-year-old man with acute leg ischemia and thrombosed popliteal artery aneurysm successfully treated with 36 hours of intraarterial urokinase. Arteriogram (femoral artery injection) at time of presentation (A) shows aneurysmal changes in superficial femoral and popliteal artery and no flow beyond popliteal artery. After 8 hours of intraarterial urokinase (250,000 unit bolus, 60,000 unit/hr infusion) nearly complete clearing of popliteal artery and runoff vessels was obtained (B) with complete clearing at 36 hours. Patient continued to received heparin until following day when he underwent aneurysm ligation and bypass grafting from common femoral artery to infrageniculate popliteal artery with reversed greater saphenous vein. This graft continues to be patent at 24 months follow-up. Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Cumulative time-to-event graft patency and limb salvage in 33 patients with popliteal artery aneurysms. Fifty-four limbs and 45 bypass grafts at risk were monitored for mean of 62 months (range 1 to 172 months). Five-year cumulative graft patency rate was 71%, and limb salvage rate was 90%. Thirty-day cumulative graft patency rate was 95% and limb salvage rate was 94%. Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Time-to-event analysis of effect of runoff on graft patency and limb salvage in patients with popliteal artery aneurysms. Graft patency (A) was significantly better for patients with two (p < 0.155, Breslow) or three (p < 0.025, MC) patent runoff vessels than those patients with single- or no-vessel runoff. There was no significant difference between graft patency of those patients with single-vessel runoff and those with no runoff (p < 0.23, Breslow). Limb salvage (B) was significantly better in those patients with two- or three-vessel runoff compared with patients with single-vessel or no runoff (p < 0.003, MC, Breslow, TW). No limbs were lost in those patients with more than single patent runoff vessel. Significantly better limb salvage rate was also found in those patients with single-vessel runoff when compared with patients with no patent runoff vessels (p < 0.028, MC). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Time-to-event analysis of effect of runoff on graft patency and limb salvage in patients with popliteal artery aneurysms. Graft patency (A) was significantly better for patients with two (p < 0.155, Breslow) or three (p < 0.025, MC) patent runoff vessels than those patients with single- or no-vessel runoff. There was no significant difference between graft patency of those patients with single-vessel runoff and those with no runoff (p < 0.23, Breslow). Limb salvage (B) was significantly better in those patients with two- or three-vessel runoff compared with patients with single-vessel or no runoff (p < 0.003, MC, Breslow, TW). No limbs were lost in those patients with more than single patent runoff vessel. Significantly better limb salvage rate was also found in those patients with single-vessel runoff when compared with patients with no patent runoff vessels (p < 0.028, MC). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Time-to-event analysis of effect of aneurysm patency or thrombosis, as determined by angiography and ultrasonography, on graft patency and limb salvage. Graft patency (A) was significantly better in those patients undergoing repair of patent popliteal artery aneurysms compared with those undergoing repair of thrombosed aneurysms (p < 0.005, MC, Breslow, TW). Limb salvage (B) was also significantly better in those patients with patent aneurysms compared with those with thrombosed aneurysms (p < 0.005, MC, Breslow, TW). No amputations occurred in patients with patent aneurysms. Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Time-to-event analysis of effect of aneurysm patency or thrombosis, as determined by angiography and ultrasonography, on graft patency and limb salvage. Graft patency (A) was significantly better in those patients undergoing repair of patent popliteal artery aneurysms compared with those undergoing repair of thrombosed aneurysms (p < 0.005, MC, Breslow, TW). Limb salvage (B) was also significantly better in those patients with patent aneurysms compared with those with thrombosed aneurysms (p < 0.005, MC, Breslow, TW). No amputations occurred in patients with patent aneurysms. Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Time to event analysis of effect of subjective complaints of symptoms (ischemia or compression) on graft patency (A) and limb salvage (B). Although there was trend toward better graft patency and limb salvage rates in symptom-free patients, this was not statistically significant (p < 0.119, MC, p < 0.06, Breslow, respectively). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Time to event analysis of effect of subjective complaints of symptoms (ischemia or compression) on graft patency (A) and limb salvage (B). Although there was trend toward better graft patency and limb salvage rates in symptom-free patients, this was not statistically significant (p < 0.119, MC, p < 0.06, Breslow, respectively). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Time-to-event analysis of effect of thrombolytic therapy on patients with thrombosed popliteal artery aneurysms. Although trend toward improved graft patency (A) and limb salvage rates (B) was detected, this did not achieve statistical significance (p < 0.12, MC; p < 0.11, Breslow, respectively). When subgroup of patients diagnosed with thrombosed aneurysms and no patent runoff vessels was compared for effect of thrombolytic therapy, graft patency, and limb salvage rates were significantly better in those patients treated with thrombolytic therapy (p < 0.005, Breslow; p < 0.01, MC, Breslow, TW, respectively). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Time-to-event analysis of effect of thrombolytic therapy on patients with thrombosed popliteal artery aneurysms. Although trend toward improved graft patency (A) and limb salvage rates (B) was detected, this did not achieve statistical significance (p < 0.12, MC; p < 0.11, Breslow, respectively). When subgroup of patients diagnosed with thrombosed aneurysms and no patent runoff vessels was compared for effect of thrombolytic therapy, graft patency, and limb salvage rates were significantly better in those patients treated with thrombolytic therapy (p < 0.005, Breslow; p < 0.01, MC, Breslow, TW, respectively). Journal of Vascular Surgery 1994 19, 65-73DOI: (10.1016/S0741-5214(94)70121-0) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions