Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3745_Библиотеки_им_академика_М_И_Перельмана

Indications for operation include size of 2 cm or greater, aneurysm of any size with mural thrombus, any patient with pain and/or swelling due to compression of adjacent structures, and any symptoms of embolization. While some surgeons prefer to delay operation in asymptomatic patients until the aneurysm reaches 3 cm in size, we believe that an aggressive approach is justified because the majority of patients ultimately become symptomatic. Some authors advocate an aggressive approach to any small, asymptomatic popliteal artery aneurysm containing mural thrombus due to the high frequency of embolization in these cases [4]. [Q3: A, B, C, D] It is important to note that thromboembolization is the most common form of pre­sentation. Accepted forms of surgical treatment include bypass with complete exclusion of the aneurysm, bypass with partial or complete resection of the aneurysm if compressive symptoms are present, or endoaneurysmorrhaphy like the open repair of AAA. The medial approach is preferred over the posterior approach because it allows for better exposure of the distal superficial femoral artery and tibioperoneal trunk, easier access to the saphenous vein, and the ability to perform distal bypass if it becomes necessary. Autogenous vein is the preferred conduit since it provides better patency than prosthetic graft. Endoluminal stent grafting has not been proven, and theoretically it would seem to be inferior to surgical repair due to the small size of the stent graft required and the lower patency rates of prosthetic graft in this position. Nevertheless, it may be an option in a patient who is at high risk for a surgical procedure.