Introduction: Popliteal artery aneurysm (PPA) belongs to the most commonly recognized peripheral
artery aneurysms. The presence of PPA complications especially the presence of PPA related acute leg
ischemia significantly increase the risk of leg amputation. In the study, the population of the elective and
emergency patients with PPA treated in the Department of General Surgery, Vascular Surgery, Angiology
and Phlebology of the Medical University of Silesia was analyzed. In the study protocol the primary and
secondary patency as well as the predictive factors for the PAA revascularization success were evaluated
in the patients with and without acute leg ischemia due to PAA.

Material and methods: 97 patients with PAA were recruited into the study including 38 patients with acute
leg ischemia (ALI). In both groups (elective and ALI) the surgical procedures related to the anatomy and
extend of PAA were performed. In the elective group in 66.1% of the cases posterior (prosthesis or vein
interposition) and in 33.9% medial approach (saphenous vein or prosthetic by pass implantation) was
used. In the ALI 57% of the patients underwent PAA surgery from the posterior approach and in 41%
the medial approach was used. In the ALI patients the following stages of the ischemia according to the
SVS classification were recognized: stage I — 21.2%, stage IIa — 65.6%, stage IIb 13.3%. In 5 patients
from this group preoperative thrombolytic treatment was performed. In the elective PAA group in 67%
of the patients intermittent claudication was noticed and in 5% critical leg ischemia was recognized. The
patients were followed 36 months and in the evaluation the patency of the reconstruction, amputation
rate as well as potential factors influencing on the reconstruction success, including run off vessel status
(assessed by run off score) were taken into account.

Results: In the elective group in the 3 year follow up 2 amputations were performed. 3 patients from this
group (5.1%) died. In the ALI group, 9 amputations (23.7%), including 4 early amputation — 10.5% in
the early postoperative period) as well as 3 deaths (7.9%) were noticed. The patency of the performed
reconstructions was significantly better in the group of the elective reconstructions — 3 years secondary
patency in this group was 61% (vs 31,5% in the ALI patients. In both groups, the significantly better results
were achieved when using autologous material (saphenous vein) with no result difference related to the
type of performed procedure (interposition from posterior approach vs by pass procedure) in the early
period as well as in the long term follow up. The poor run off status of the below the knee arteries had the
significant impact on the long term patency in the elective group as well as on the early reconstruction
thrombosis and leg amputation in the ALI group. In the patients with the higher advancement of the leg
ischemia, both chronic and acute, the significantly worse patency rate in the late follow up was noticed.
Among the other identified factors influencing on the long term results, the advanced age in the elective
and thrombotic occlusion of the popliteal artery in the ALI group were noticed.

Conclusions: PAA related acute leg ischemia significantly increases the risk of the early amputation rate. In
the planning of the treatment procedure in the patients with PAA and ALI, the use of the autologous material
as well as the proper run off vessel assessment and, if needed, run off vessel patency restoration should
be taken into consideration. In contrary to ALI patients, in the elective PAA treatment the run off vessel
score assessment, the stage of the leg ischemia as well as the presence of the possible popliteal artery
occlusion have limited value in the direct prediction of the early revascularization results. Independently
from the type of the reconstruction, in both groups, elective and ALI, the optimal results can be achieved
when using the revascularization based on the own saphenous vein implementation.