How to proceed with a patent popliteal artery aneurysm below the chronic superficial femoral artery occlusion?

Introduction: The indications for popliteal artery aneurysm treatment are clear. In aneurysms with patent inflow and outflow arteries, the risk of peripheral embolisation from a mural thrombus is high and the treatment, mostly a vascular intervention, is focused on preventing this extremity- threatening complication. It is unclear, however, how high the risk of peripheral embolisation is and how to proceed with a patent popliteal artery aneurysm fed by the deep femoral artery when the superficial femoral artery is chronically occluded. Methods: All patients diagnosed with popliteal artery aneurysm between 2015 and 2019 were searched in the database of the Department of Surgery II of University Hospital Olomouc. Patients with a patent popliteal artery aneurysm and chronic superficial femoral artery occlusion in the ipsilateral extremity were selected. Results: We diagnosed 66 patients with 85 popliteal artery aneurysms. Four patients had a patent popliteal artery aneurysm and chronic superficial femoral artery occlusion in the ipsilateral extremity. In these patients, conservative treatment was indicated after the diagnosis was determined. In three patients, no clinically obvious complication of the popliteal artery aneurysm occurred. In one patient, popliteal artery aneurysm thrombosis occurred after a follow-up of 21 months, leading to a shortening of his calf claudication distance and limiting the patient. Conclusion: Our experience with this small group of patients shows the possibility of primary conservative treatment in patients with a patent popliteal artery aneurysm below the chronic superficial femoral artery occlusion site. Aneurysm thrombosis can be expected during follow-up. Patients in whom the thrombosis leads to limitations are indicated for surgical intervention. The risk of peripheral embolisation from the mural thrombus cannot be excluded with certainty. Further studies involving large groups of patients are needed to provide a more precise recommendation.