Graft replacement was performed for 123 (77%) of 160 popliteal aneurysms evaluated at The Cleveland Clinic from 1952 to 1984, employing autogenous saphenous vein in 58 (36%), polytetrafluoroethylene in 19 (12%), and of historic interest, Dacron (12%) or arterial homograft (16%) in 46. The 10-year cumulative patency (CP) rate was 56% and the limb salvage (LS) rate was 83% following graft replacement, but late results were superior in patients who received vein bypass (CP, 94%; LS, 98%), in those who underwent revascularization before ischemic complications had occurred (CP, 92%; LS, 96%), and in those who recovered both pedal pulses (CP, 64%; LS, 96%). Long-term asymptomatic limbs were restored in 96%, 92%, and 89% of these subsets, respectively, compared with 65% of those receiving other graft materials (p = 0.00003), 59% of those with preoperative ischemic symptoms (p = 0.00001) and 68% of those regaining only an isolated popliteal pulse (p = 0.0326). These data indicate that popliteal aneurysms should be corrected by vein bypass to a patent tibioperoneal segment before spontaneous thrombosis or embolization eliminates the critical outflow bed.

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Graft replacement was performed for 123 (77%) of 160 popliteal aneurysms evaluated at The Cleveland Clinic from 1952 to 1984, employing autogenous saphenous vein in 58 (36%), polytetrafluoroethylene in 19 (12%), and of historic interest, Dacron (12%) or arterial homograft (16%) in 46. The 10-year cumulative patency (CP) rate was 56% and the limb salvage (LS) rate was 83% following graft replacement, but late results were superior in patients who received vein bypass (CP, 94%; LS, 98%), in those who underwent revascularization before ischemic complications had occurred (CP, 92%; LS, 96%), and in those who recovered both pedal pulses (CP, 64%; LS, 96%). Long-term asymptomatic limbs were restored in 96%, 92%, and 89% of these subsets, respectively, compared with 65% of those receiving other graft materials (p = 0.00003), 59% of those with preoperative ischemic symptoms (p = 0.00001) and 68% of those regaining only an isolated popliteal pulse (p = 0.0326). These data indicate that popliteal aneurysms should be corrected by vein bypass to a patent tibioperoneal segment before spontaneous thrombosis or embolization eliminates the critical outflow bed.

From 1973 through 1984, graft replacement of infrarenal aortic aneurysms (N = 56) or occlusive disease (N = 33) was performed in conjunction with simultaneous renal revascularization in 89 patients. Isolated renal artery stenosis was corrected by unilateral reconstruction in 56 patients (63%), but the remaining 33 (37%) had diffuse involvement that required either bilateral renal artery grafts or unilateral revascularization of solitary kidneys. The incidence of hypertension (greater than 180/90 mm Hg) refractory to preoperative medical therapy (88%), severe coronary disease documented by angiography (40%), and postoperative azotemia (33%) or oliguric renal failure (15%) was significantly higher among patients with bilateral renal artery disease (p less than 0.05). In addition, this group had twice the early mortality rate (15%) of patients having unilateral renal artery lesions (7.1%). During a mean follow-up interval of 37 months, medical control of hypertension was enhanced in 46 of the 80 operative survivors (58%), and renal function improved or remained stable in 63 survivors (79%). Five-year actuarial survival presently is 65% for the entire series, with a cumulative mortality rate of 38% among patients who underwent aneurysm resection (mean age 64 years) in comparison to 15% (p = 0.03) for those patients with aortoiliac occlusive disease (mean age 60 years).

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