Diagnosis and Management

IN THE FIELD of medicine there are few conditions presenting a threat to life and limb that are as readily diagnosable before the occurrence of catastrophe as aneurysms of the popliteal artery. Moreover, this is a patho-logic condition that has been amenable to surgical attack for 200 years, since John Hun-ter performed femoral artery ligation in the adductor canal. In spite of the potential ease of diagnosis and the availability of successful therapy, most popliteal aneurysms are al-lowed to go on to disastrous complications, either unrecognized or untreated. The high incidence of complications has been shown by Gifford, Hines, and Janes ' in an analysis of 100 cases of popliteal aneu-rysms. They described acute thromboses in 20 cases, rupture of the aneurysm in 16, periph-eral emboli from the aneurysm in 14, and gan-grene of the extremity in 24 cases. In addition they reported a limb loss of 23 per cent fol-lowing conservative treatment, as compared to 8 per cent following surgical intervention. Linton2 reported an amputation rate of 77 per cent in untreated cases. In his series of operative cases, sympathectomy followed by aneurysmectomy, there were no amputations. Other reports3-8 have indicated equally good results following surgical intervention. Liord9 advocated endoaneurysmorrhaphy in patients who are poor surgical risks or who have no distal pulses. In good-risk patients and ill those with pedal pulses he employed venous autografts. Austin and Thompson3 and Bahn-son4 have had success with homografts, and Julian et al.6 reported the restoration or pres-ervation of ankle pulses in seven of nine cases with the use of venous autografts or homo-grafts. These series indicate the generally success