A 50-year-old man undergoes abdominal CT for flank pain and is incidentally found to have a 3.5 cm popliteal artery aneurysm bilaterally. He has no symptoms of distal embolisation or thrombosis. According to current guidelines, what is the most appropriate management?
- A Urgent surgical bypass grafting
- B Ultrasound surveillance every 6 to 12 months ✓
- C Endovascular stenting of both aneurysms
- D Systemic anticoagulation with warfarin
Correct answer: B. Ultrasound surveillance every 6 to 12 months
Explanation
Asymptomatic popliteal artery aneurysms under 2 cm are monitored with surveillance ultrasound. Aneurysms 2 cm or larger, or those with thrombus, may warrant repair, but a 3.5 cm asymptomatic aneurysm in a patient without high surgical risk is typically managed with surveillance. Bypass is reserved for symptomatic or complicated aneurysms. Anticoagulation alone does not prevent aneurysm complications.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
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