trans-atlantic debate: nonoperative versus surgical management of small (less than 3 cm),...

Eur J Vasc Endovasc Surg (2011) 41, 445e449

EDITORS’ INTRODUCTION

Trans-Atlantic Debate: Nonoperativeversus Surgical Management of Small(less than 3 cm), AsymptomaticPopliteal Artery Aneurysms*

J.-B. Ricco a,*, T.L. Forbes b

aDebate Section Editor, European Journal of Vascular andEndovascular Surgery, Poitiers, FrancebDebate Section Editor, Journal of Vascular Surgery,London, Ontario, Canada

Popliteal artery aneurysms represent a common pathologythat vascular surgeons are often confronted with. However,several issues remain incompletely understood, includingindications for intervention and optimal methods of treat-ment. In the following paper, our discussants debate theappropriate management of small popliteal artery aneu-rysms. Further complicating this discussion is the unclearrelationship between popliteal artery aneurysm diameterand subsequent complications. Whereas with abdominalaortic aneurysms diameter is linked to rupture risk, it is lessclear with popliteal artery aneurysms where complicationsare more likely to include thrombosis, embolization andcompression whether aneurysm diameter is accuratelypredictive. Perhaps other anatomic features should beincluded in our management algorithms? Regardless, ourdebaters will try to convince us whether small poplitealartery aneurysms warrant repair or not.

doi: 10.1016/j.ejvs.2011.02.005

* This paper is also being published in the Journal of VascularSurgery.* Corresponding author. University Hospital Jean Bernard,

Department of Vascular Surgery, 86021 Poitiers, France. Tel.: þ33 549 44 38 46; fax: þ33 5 49 50 05 50.

E-mail address: jbricco2@me.com (J.-B. Ricco).

Part One: For the Motion.Asymptomatic Popliteal ArteryAneurysms (less than 3 cm)Should be TreatedConservatively

J.E. Cross, R.B. Galland *

Department of Surgery, Royal Berkshire Hospital, LondonRoad, Reading, Berkshire RG1 5AN, UK

Popliteal aneurysm (PAA) management has beenconfounded by paradox and controversy. Until the start ofthe 20th century the principle of management was toinduce thrombosis within the aneurysm either bycompression or ligation.1 Subsequently the aim of treat-ment was to prevent thrombosis from happening! This is theparadox. Controversial aspects of their treatment includethe use of intra-arterial thrombolysis for thrombosedPAAs,2e4 which operation to carry out, what approach touse and whether an endovascular repair is appropriate.5,6

However, the greatest controversy is probably when tooperate on an asymptomatic PAA.

Demographics and Natural History

PAAs account for more than 80% of all peripheral aneu-rysms, having a prevalence of approximately 1% in menaged 65e80 years.7 They are mostly atherosclerotic inorigin: other rarer causes include infection, trauma,familial or those associated with Marfan’s and Behcet’s

To access continuing medical education questions on thispaper, please go to www.vasculareducation.com and click on ‘CME’* Corresponding author. Tel.: þ44 118 987 7419; fax: þ44 118 987

7881.E-mail address: Robert.Galland@royalberkshire.nhs.uk

(R.B. Galland).