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Objectives: Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women., Methods: Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry., Results: 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion of small aneurysms (<2 cm) among women than men (24% vs. 8%, p=.005), there was no such difference in asymptomatic aneurysms. Distribution between asymptomatic and symptomatic PA was 31% versus 69%, similar to men. The prevalence of concomitant aneurysms in the aorto-iliac and femoral arteries, and the frequency of presenting symptoms were similar compared with men. Three PA were ruptured (3.7%). Thrombolysis was used in 23 of 45 legs treated for acute ischaemia (51%). Eight legs were treated with endovascular stent grafts (9.8%), compared with 7.9% in men (p=.5). Seven legs were amputated (8.6%). Crude survival was similar to men., Conclusions: PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often <2 cm in diameter. Women had the same survival as men, despite women generally having better life expectancy. Although the largest series ever published on women with PA, the sample size is small, making it prone to type II statistical error., (Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Popliteal aneurysm (PA) is traditionally treated by open repair (OR). Endovascular repair (ER) has become more common. The aim was to describe time trends and compare results (OR/ER)., Methods: The Swedish vascular registry, Swedvasc, has a specific PA module. Data were collected (2008-2012) and supplemented with a specific protocol (response rate 99.1%). Data were compared with previously published data (1994-2002) from the same database., Results: The number of operations for PA was 15.7/million person-years (8.3 during 1994-2001). Of 592 interventions for PA (499 patients), 174 (29.4%) were treated for acute ischaemia, 13 (2.2%) for rupture, 105 (17.7%) for other symptoms, and 300 (50.7%) were asymptomatic (31.5% were treated for acute ischaemia, 1994-2002, p = .58). There were no differences in background characteristics between OR and ER in the acute ischaemia group. The symptomatic and asymptomatic groups treated with ER were older (p = .006, p < .001). ER increased 3.6 fold (4.7% 1994-2002, 16.7% 2008-2012, p = .0001). Of those treated for acute ischaemia, a stent graft was used in 27 (16.4%). Secondary patency after ER was 70.4% at 30 days and 47.6% at 1 year, versus 93.1% and 86.8% after OR (p = .001, <.001). The amputation rate at 30 days was 14.8% after ER, 3.7% after OR (p = .022), and 17.4% and 6.8% at 1 year (p = .098). A stent graft was used in 18.3% for asymptomatic PA. Secondary patency after ER was 94.5% at 30 days and 83.7% at 1 year, compared with 98.8% and 93.5% after OR (p = .043 and 0.026). OR was performed with vein graft in 87.6% (395/451), with better primary and secondary patency at 1 year than prosthetic grafts (p = .002 and <.001), and with a posterior approach in 20.8% (121/581)., Conclusions: The number of operations for PA doubled while the indications remained similar. ER patency was inferior to OR, especially after treatment for acute ischaemia, and the amputation risk tended to be higher, despite similar pre-operative characteristics., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Short relative telomere length (RTL) is associated with vascular ageing, inflammation and cardiovascular risk factors. Previous studies have reported an association between abdominal aortic aneurysm and short RTL. The presence of atherosclerosis among patients with aneurysm disease may, however, be a confounder. The aim was to explore the associations between short RTL and aneurysm disease, by comparing patients with isolated popliteal artery aneurysms with those having multiple aneurysms., Design and Patients: DNA was retrieved from 183 patients with popliteal artery aneurysm (PAA). They were all examined with ultrasound at the time of blood-sampling, and had a total of 423 aneurysms (range 1-7, mean 2.3/patient)., Methods: TL was measured with Real-Time PCR, RTL was calculated by comparing with three reference populations., Results: Patients with bilateral PAAs had a mean RTL of 0.985 vs. 1.038 with unilateral PAAs (P = 0.326). Patients with abdominal aortic aneurysm had RTL 1.035, vs. 0.999 without (P = 0.513). No difference was seen with or without femoral or iliac aneurysms. Fifty-six patients with isolated PAA at surgery and at re-examination had RTL 0.974, vs. 1.033 who had >1 aneurysm (P = 0.308). RTL was not associated with the number of aneurysms at re-examination (P = 0.727, one-way ANOVA). There was a trend towards shorter RTL among active smokers (0.93 vs. 1.04, P = 0.066)., Conclusions: No association between short RTL and multiple aneurysm disease was found. The previously reported association between AAA and short RTL may be secondary to cardiovascular risk factors, rather than by aneurysm disease., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

PAA is a predominantly male disease, more than 90% of affected patients are men. Risk factors for amputation are poor run-off, use of a synthetic graft, emergency treatment and high age. The frequency of amputation decreased over time in Sweden, which was associated with increased use of preoperative thrombolysis and fasciotomy. Thrombolysis can transform an emergent into an elective situation, and often improves out-flow. The risk of late amputation is low. Operation with a Posterior approach is associated with lower risk of late expansion, and is considered first choice of treatment when a short by-pass is sufficient. Multiple aneurysm disease is common among patients with PAA, in particular among those with bilateral PAA. All patients, irrespective of age, should be included in a life-long surveillance program. Normal arterial segments should be re-examined after three years.

Background: The risk of developing a new aneurysm after surgery for popliteal artery aneruysm (PAA) is not well known. The aim was to study this risk in a cohort of patients., Methods: A total of 571 patients who had primary operation for PAA (717 legs) between 1987 and 2002 were identified from the Swedish Vascular Registry (Swedvasc). Of these, 190 patients were re-examined by ultrasonography after a median of 7 (range 2.9-18.7) years., Results: The number of patients with at least one aneurysm in addition to the PAA was 108 (56.8 per cent) at the index operation and 131 (68.0 per cent) at re-examination. The overall number of aneurysms increased by 41.8 per cent, from 244 to 346. Among the 82 patients who had an isolated PAA at the index operation, 23 developed a new aneurysm; these patients tended to be older (P = 0.004). Bilateral PAA at the index operation was associated with a later development of abdominal aortic aneurysm (P = 0.004). Age (P = 0.004) and hypertension (P = 0.012) at the time of the index operation were associated with multianeurysm disease at any time. Six (4.3 per cent) of 138 legs treated by venous bypass grafts had developed a graft aneurysm by the time of re-examination. No normal arterial segment developed an aneurysm that required surgery within 3 years., Conclusion: The development of new aneurysms was common in patients with a PAA; lifelong surveillance may be warranted., (2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Background: The aim was to study the epidemiology and outcomes of popliteal artery aneurysm (PA) treated surgically., Methods: Among 110,000 procedures registered prospectively in the Swedish Vascular Registry (Swedvasc), there were 717 primary operations for PA among 571 patients. Patient records were reviewed and data validated against other registries., Results: The median age of the patients was 71 years; 5.8 per cent were women. Among 264 legs treated urgently, 235 had acute ischemia and 24 had rupture. Of patients with unilateral PA, 28.1 per cent had an aortic aneurysm, 8.4 per cent an iliac aneurysm and 9.4 per cent a femoral aneurysm. Extra-popliteal aneurysms were more common when the PAs were bilateral (P = 0.004). The rate of limb loss within 1 year of operation was 8.8 per cent; 12.0 per cent for symptomatic and 1.8 per cent for asymptomatic limbs (P < 0.001). Risk factors for amputation were symptomatic disease, poor run-off, urgent treatment, age over 70 years, prosthetic graft and no preoperative thrombolysis when the ischaemia was acute. Amputation rates decreased over time (P = 0.003). Crude survival was 91.4 per cent at 1 year and 70.0 per cent at 5 years., Conclusion: Multiple aneurysm disease was common when PAs were bilateral. Preoperative thrombolysis of acute thrombosis and the use of vein grafts for bypass improved outcome., (Copyright (c) 2007 British Journal of Surgery Society Ltd.)

Background: This study investigated the importance of surgical technique on long-term outcome after treatment of popliteal artery aneurysms (PAAs)., Methods: Records from 571 patients (717 legs) primarily operated on for PAAs were identified in the Swedish Vascular Registry. Surgical approach, type of graft, and anastomotic and ligation techniques were studied. After mean 7.2 years (range, 2 to 18 years) information on amputation was obtained for all patients, and 190 patients were re-examined with ultrasound imaging., Results: The approaches used were medial (medial approach group, MAG) in 87%, posterior (PAG) in 8.4%, endovascular in 3.6%, and other in 1.4%. Primary patency at 1 year with venous and prosthetic grafts was 85% vs 81% in the PAG (P = .719) and 90% vs 72% in the MAG (P < .001). Sixty-three legs (8.8%) were amputated

Objectives: The aim of this study was to assess the national management and outcome of popliteal artery aneurysm (PAA)., Methods: In the Swedish National Registry 717 primary operations for PAA on 571 patients were registered prospectively between 1987 and 2002. 235 legs [corrected] presented with acute ischemia., Results: Median age was 70 for men and 75 for women. Immediate surgery was performed in 135 legs, including intraoperative thrombolysis in 32 cases (Immediate Surgery Group, ISG). Pre-operative thrombolysis was performed in 100 legs, followed by acute (