When to talk about a popliteal aneurysm?
A popliteal aneurysm with a diameter of more than 20 mm or a diameter of more than 50% of the native artery is referred to.
The prevalence is 1% in the general population.
The causes are: atherosclerosis (the most frequent), trauma, infectious diseases, autoimmune diseases, inflammatory diseases (Behcet’s disease …), elastorexia.
What are the manifestations?
In 80% of cases, they are ASYMPTOMATIC. Of these 80%, 14% will become symptomatic.
The 20% SYMPTOMATICS are in the form of:
– Acute ischemia +++ (the complication to be feared) because complicated by 50% transfemoral amputation.
– Pain, discomfort in walking.
– Deep vein thrombosis.
– Tibial compressional neuralgia
– Distal embolisms: critical lower limb ischemia
Which screening tool?
ARTERIAL ECHO-DOPPLER OF LOWER MEMBERS
Who to track?
– No systematic screening.
– Any patient with a popliteal pulse “too well perceived” (level B recommendation).
Patient with an aneurysm of the abdominal aorta.
What pace of surveillance?
– <17mm: clinical monitoring and arterial echo-doppler of the lower limbs annually.
-> 17mm: Clinical monitoring and echo-Doppler arterial lower limbs every 6 months.
What general care should be provided by the attending physician?
- When discovering a popliteal aneurysm, there is a benefit to offer:
- Platelet antiplatelet therapy (aspirin) (Level B recommendation).
- Place an anticoagulant treatment? Rare, only to discuss in cases of popliteal aneurysm in patient contraindicated in surgery.
- Treatment with STATINE and I.E.C. Seems also to have a benefit in the context of atherosclerotic disease
- Correction of hypertension.
- Correction of dyslipidemia
- Correction of diabetes
- Smoking cessation.
- Regular Physical Activity
When to operate?
– ALL SYMPTOMATIC ANEURISMS.
– ASYMPTOMATIC ANEVRISM SI:> 2cm, or small aneurysms if intraluminal thrombus at risk of embolism, if notion of distal embolism downstream.
Who to operate?
- Patients with good life expectancy.
Who does not operate?
- In patients with low life expectancy: AVK anticoagulant therapy may be used in these patients.
What are the different interventions?
– Conventional surgery: several techniques exist: bypass with bipolar exclusion, bridging with flattening posteriorly, transposition of superficial femoral artery.
– Endovascular surgery: implantation of a covered viabahn endoprosthesis.
What follow-up of the patient?
In the operated patient, follow-up should be for life through an aortic arterial echo-doppler assessment and lower annual limbs for:
– Detect complications due to revascularization.
– The search for associated aneurysms (aortic, contralateral popliteal). One out of two popliteal aneurysms is bilateral and 40% of popliteal aneurysms are associated with an abdominal aortic aneurysm.
French College of Vascular Surgery: http://www.cfcv.fr/reperes.htm
American Society of Cardiology: http://circ.ahajournals.org/content/early/2013/03/01/CIR.0b013e31828b82aa.full.pdf