Conservative Management of Popliteal Aneurysm: Is There a Role for Selective Observation?

Abstract

Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, comprising 70% of these lesions. More than two thirds of these patients have bilateral aneurysms and the most common etiology is atherosclerosis. Elderly men in their sixth and seventh decade of life constitute over 90% of these patients, and up to 55% will have an aneurysm in other portions of the vascular tree. Only 3% to 5% of these aneurysms are found in women. The abdominal aorta will be involved in 30% to 75% of cases and, therefore, dictate a full work-up when a PAA is found.

The authors report a case of an 80-year-old man with a chief complaint of intermittent calf pain that occurred without any pattern of distance. This atypical pattern of claudication had been recurring for more than three months. The patient underwent a duplex ultrasound that showed a dilation of his arteries measuring 1.7 cm and 2.3 cm on the right and left sides, respectively. Further work-up with a magnetic resonance image demonstrated a 4 cm x 3 cm left PAA with thrombus and a smaller aneurysm on the right side. An angiogram demonstrated single peritoneal artery runoff on the left side and posterior tibial artery runoff on the right side. The patient was cleared for surgery with an ejection fraction of 40%; however, he refused to undergo reconstruction. The patient ehas been followed up for the past four years without change in his symptomatology and repeated ultrasounds have not shown any significant size change.

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