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16 It is interesting to note that only nine patients in this study reached diameters of >2 cm. The Swedish study quoted earlier11 reported that 96.4% of asymptomatic aneurysms smaller than 2 cm had more than 2 mm of thrombus in the wall of the aneurysm. PAs with thrombus are generally larger than those without. It is Transferase reasonable to assume that as the aneurysm enlarges thrombus will develop. However, there is no evidence to support the theory that presence of thrombus indicates a high risk aneurysm. Large emboli usually produce an obvious clinical picture. In many patients, microembolization of the peripheral circulation occurs silently. Compromise of the runoff can impact adversely on the outcome from bypass surgery. Once embolization occurs the aneurysm cannot be regarded as being asymptomatic and therefore surgical repair should be considered. Poor runoff secondary to embolization has been suggested as being an indication for early repair. Evidence supporting this is sparse. One retrospective study17 demonstrated a greater risk of complications developing in those PAA associated with no distal pulses compared with those having distal pulses. Statins have been shown to be associated with less likelihood of severe ischemia developing, whereas antiplatelet medication and lipid levels were no different in patients with or without thrombosed PAAs.13 All patients with PAAs should have ��best medical treatment�� as recommended to anyone with cardiovascular disease. They should be assessed for the presence of other aneurysms. Fasudil datasheet GPCR Compound Library chemical structure Management of asymptomatic popliteal artery aneurysms remains controversial. It is clear that no single criterion is sufficiently robust to identify reliably high risk PAAs. Using a cut-off >2 cm diameter alone as an indicator for elective repair will subject an unacceptably large number of patient to unnecessary morbidity and mortality. However, combining risk factors may be more useful. Size and distortion appear to be a more reliable means of identifying high risk aneurysms than size alone. Key message: Asymptomatic popliteal aneurysms measuring less than 3 cm in diameter should be treated conservatively �� �� �� providing that there is no significant distortion of the aneurysm. Anil Hingorani, MD, and Enrico Ascher, MD,Brooklyn, NY In our prior review of 34 popliteal artery aneurysms (PAAs),1 we suggested that small PAA were associated with higher incidence of thrombosis, clinical symptoms, and distal occlusive disease. This was based upon the liberal use of duplex scanning to make the diagnosis.2?and?3 We concluded that small PAAs (