Ruptured Popliteal Aneurysms: Clinical Presentation and Outcome in a Nationwide, Population-based Study

Introduction - Popliteal aneurysms (PA) are complicated by thrombosis and distal embolization, whereas rupture is rare. The aim of this study is to describe the clinical characteristics and outcome in a relatively large cohort of patients with ruptured PA (rPA). Methods - Operations for rPA were identified in the national vascular registry, 1987-2012. The registry is automatically linked to the population registry, permitting accurate long-term data on survival. Medical records were reviewed, as well as all imaging in a core facility. Comparisons with patients treated for PA without rupture were performed. Results - Forty-five patients with rPA were identified. The proportion of rupture among all those operated on for PA was 2.5 %. Compared with patients treated for other indications, the patients with rupture were eight years older (77.7 versus 69.7 years, p<0.001), had more lung and heart disease (p=0.003 and 0.023), and the mean diameter was larger, 63.7 mm versus 30.9 mm (p <0.001). There was no correlation between age and diameter (Pearson r= 0.046, p=0.777). At the time of surgery, 49% (22/45) were treated with anticoagulants, seven on indication deep venous thrombosis (DVT) in the affected leg. There was extensive swelling of the whole leg in 44.4% (20/45). In 27 (60%) patients, the initial diagnosis was DVT or a Baker’s cyst. The initial diagnosis was rPA (i.e. correct) in only eight cases (17.8%), half of whom had a previously known diagnosis of PA. Most patients were operated on by open surgery through the medial approach. Fasciotomi was performed in twelve (26.7%). There were four amputations (8.9%), all performed within a week of surgery. One year after surgery, 58% (26/45) of the patients were alive. Among those, the reconstructions were patent in 83% (20/24). Conclusion - The diagnosis of rPA is difficult, and the initial diagnosis is often incorrect. The condition affects old patients, who often are on anticoagulation treatment, and have large aneurysms. The immediate surgical results are acceptable, but the condition is associated with a high mortality within the first year.