Medical treatment of postoperative complications of popliteal artery aneurysm surgery (original) (raw)
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A 33-year experience with surgical management of popliteal artery aneurysms
Journal of Vascular Surgery, 2015
This study retrospectively analyzed our 33-year experience with surgical management of popliteal artery aneurysms (PAAs), with particular attention paid to early and long-term results. Methods: From January 1981 to December 2013, 234 open surgical interventions for PAA were performed in 196 patients. Data concerning these interventions were collected in a dedicated database containing main preoperative, intraoperative, and postoperative features. Early (intraoperative and <30 days) results were analyzed for mortality, thrombosis, reintervention, and amputation rates. The follow-up program consisted of clinical and duplex ultrasound examinations at 1 month and yearly thereafter. Patients who did not accomplish follow-up examinations were interviewed by telephone. Additional data regarding long-term survival and major clinical events were obtained from the Regional Health Care database. Follow-up results were analyzed for survival, primary and secondary patency, and amputations rates. Results: Patients were predominantly males (186 [95%]), with a mean age of 68.5 6 9.9 years. The PAA was asymptomatic in 97 limbs, intermittent claudication was present in 68, and limb-threatening ischemia was present in 62. Aneurysmal rupture occurred in six patients, and venous compression with leg swelling and pain was present in one patient. The intervention consisted of aneurysmal ligation and bypass grafting in 122 interventions, aneurysmectomy with graft interposition was used in 108, and four patients underwent aneurysmectomy with an end-to-end anastomosis. An autologous vein was used in 49 interventions, and a prosthetic graft was used in 181. In 71 interventions a posterior approach was used, and in the remaining 163, a medial approach was preferred. There were two perioperative deaths, with a cumulative mortality rate of 1%. Perioperative thrombosis occurred after 18 interventions (7.7%). A successful reintervention was performed in 10 of those patients, whereas surgical thrombectomy was ineffective in one patient and leg amputation was necessary. The remaining seven patients underwent major amputation without any new surgical attempt. An adjunctive major amputation was necessary in a patient with a patent bypass for irreversible foot ischemia. The cumulative rate of amputations at 30 days was 3.8% (9 of 234 limbs). Mean duration of follow-up was 62 months (range 1-312 months). During follow-up, 31 deaths, 45 thromboses, and 10 amputations were recorded. The estimated 13-year survival rate was 50.8% (standard error [SE], 0.07%); during the same interval, primary patency, secondary patency, and limb preservation rates were 55.1% (SE, 0.05%), 68% (SE, 0.05%), and 86% (SE, 0.04%). Conclusions: Open surgical repair of PAAs provided good results in our experience, with low rates of perioperative complications and an excellent durability in the very long-term setting, representing the benchmark for alternative techniques such as endovascular repair.
Surgical management of popliteal artery aneurysms: Which factors affect outcomes?
Journal of Vascular Surgery, 2006
Objective: Popliteal artery aneurysm (PAA) is uncommon. The clinical presentation of PAA includes rupture, embolism, and thrombosis. In this article, we evaluate the results of our 20-year experience with surgical management of PAAs, analyzing the role of anatomic, clinical, and surgical factors that potentially affect early and long-term results. Methods: From January 1984 to December 2004, 159 PAAs in 137 patients were operated on at our department. Data from all the patients were retrospectively collected in a database. PAAs were asymptomatic in 67 cases (42%); 5 (3%) PAAs were ruptured. In 51 cases (32%), PAA caused intermittent claudication. The remaining 36 limbs (23%) had threatening ischemia due in 30 cases to acute PAA thrombosis, in 4 cases to chronic PAA thrombosis, and in 2 cases to distal embolization. In selected patients with acute ischemia, preoperative intra-arterial thrombolysis with urokinase was performed. Early results in terms of mortality, graft thrombosis, and limb salvage were assessed. Follow-up consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Long-term survival, patency, and limb salvage rates were analyzed. Results: Forty cases were treated with aneurysmectomy and prosthetic graft interposition; in 39 cases, the aneurysm was opened, and a graft was placed inside the aneurysm. Four patients had aneurysmectomy with end-to-end anastomosis. In 73 cases, ligation of the aneurysm with bypass grafting (39 with a prosthetic graft and 34 with an autologous vein) was performed. The remaining three patients underwent endovascular exclusion of their PAAs. A medial approach was used in 97 patients (61%), and a posterior approach was used in 59 patients (37.1%). The outflow vessel was in most cases (93.7%) the below-knee popliteal artery. Thirty-day amputation and death rates were 4.4% (7/159 limbs) and 2.1% (3/137 patients), respectively. The amputation rate was significantly higher in symptomatic limbs than in asymptomatic ones (6.5% and 1.4%, respectively; P ؍ .05). Eight limbs (5%) had an early graft thrombosis that required a reintervention. . The cumulative estimated 60-month survival, limb salvage, and primary and secondary patency rates were 84.2%, 86.7%, 66.3%, and 83.6%, respectively. Asymptomatic limbs had significantly better results than symptomatic ones in terms of limb salvage (93.4% and 80.4%, respectively; P ؍ .03; log-rank, 4.2) and primary patency (86.5% and 51.6%, respectively; P ؍ .001; log-rank, 10.3). Among symptomatic patients, results were better in claudicant limbs than in acutely ischemic ones in terms of limb salvage (90.5% and 58.7%, respectively; P ؍ .001; log-rank, 17.5). Univariate analysis showed the absence of symptoms, the presence of two or three tibial vessels, the use of a posterior approach, the kind of intervention, and the site of distal anastomosis to significantly affect long-term patency. Cox regression for factors affecting 60-month primary patency showed that clinical presentation, runoff status, and the site of distal anastomosis significantly influenced long-term results. Conclusions: Results of surgery on asymptomatic PAAs are good-significantly better than those for symptomatic ones. Elective surgical intervention should be performed in patients with a low surgical risk and a long life expectancy when the correct indication exists. In thrombosed aneurysms, intra-arterial thrombolysis may represent an alternative to emergent surgical management. Our data demonstrated that results are similarly good in claudicants, and this fact confirms that only acute ischemia due to PAA thrombosis represents a real surgical challenge. In selected patients with focal lesions, a posterior approach seems to offer better long-term results. The runoff status and the site of distal anastomosis affect long-term patency as well. ( J Vasc Surg 2006;43:481-7.)
Popliteal Artery Aneurysms: A Literature Review and Case Study
2018
Introduction: Popliteal artery aneurysms (PPAs) are localized and irreversible dilations of the popliteal artery walls. PPA is an uncommon condition, despite which the popliteal artery constitutes the second most frequent location for true aneurysms, second to the aorta, and is the most common location for peripheral aneurysms. It primarily affects male patients with a mean age of 65 years, its effects are mainly ischemic, and patients suffering from it require leg amputation around 7% to 20% of the times. Our goal is to present a case of PPA with subacute arterial ischemia, along with a literature review. Case study: we introduce the case of a 63 years old patient with lower limb pain and no pulse. He was diagnosed with developed subacute ischemia, and it was determined that the patient’s condition was not stable, precluding revascularization. The patient’s leg was amputated as an emergency measure. Dissecting the patient’s limb revealed the presence of PPA. Discussion: The inciden...
Popliteal aneurysms: a 10-year experience
European Journal of Vascular and Endovascular Surgery, 1998
Background: Popliteal aneurysms account for 70% of peripheral arterial aneurysms and, if untreated, pose a serious threat to the affected limb. Debate continues about the best form of treatment especially for asymptomatic lesions. Method: We reviewed the computer records and charts of patients seen at this department with a diagnosis of popliteal aneurysm over the last 10 years. Patients who had not been seen within the last year were followed-up through their G.P. Results: Twenty-four patients (M 23/F 1) presented with 40 popliteal aneurysms. The mean age was 63.5 +_9 years. Symptoms were present in 23 of the affected limbs while 17 were asymptomatic. Thirty were treated surgically and 10 followed with regular ultrasound. The mean diameter of the repaired aneurysms was 3.3 +_ 1 cm. Aneurysms <2 cm were more likely to be asymptomatic. No limbs were lost in patients undergoing elective repair of popliteal aneurysms. The secondary pateney and limb salvage rates at 3 years were 84% and 96% respectively. Conservative management of asymptomatic lesions <2 cm was not complicated by the development of symptoms.
Surgical management of popliteal aneurysms
Journal of Vascular Surgery, 1986
Graft replacement was performed for 123 (77%) of 160 popliteal aneurysms evaluated at The Cleveland Clinic from 1952 to 1984, employing autogenous saphenous vein in 58 (36%), polytetrafluoroethylene in 19 (12%), and of historic interest, Dacron (12%) or arterial homograft (16%) in 46. The 10-year cumulative patency (CP) rate was 56% and the limb salvage (LS) rate was 83% following graft replacement, but late results were superior in patients who received vein bypass (CP, 94%; LS, 98%), in those who underwent revascularization before ischemic complications had occurred (CP, 92%; LS, 96%), and in those who recovered both pedal pulses (CP, 64%; LS, 96%). Long-term asymptomatic limbs were restored in 96%, 92%, and 89% of these subsets, respectively, compared with 65% of those receiving other graft materials (p = 0.00003), 59% of those with preoperative ischemic symptoms (p = 0.00001) and 68% of those regaining only an isolated popliteal pulse (p = 0.0326). These data indicate that popliteal aneurysms should be corrected by vein bypass to a patent tibioperoneal segment before spontaneous thrombosis or embolization eliminates the critical outflow bed. (J VAse St3RG 1986; 3:125-34.)
European Journal of Vascular and Endovascular Surgery, 2010
Objectives: A systematic review was performed to summarise outcomes of acute thrombosed popliteal artery aneurysms (PAAs) treated with thrombolysis or thrombectomy followed by bypass. using the Cochrane Library, MEDLINE and EMBASE databases. Primary endpoint was limb salvage; secondary endpoints were mortality and patency of the bypasses. Results: Eight prospective studies and 25 retrospective studies with 895 patients presenting with acute ischaemia were included. No randomised trials were included. The mortality rate after surgical repair was 3.2% (95% confidence interval (C.I.) 1.8e4.6). The amputation rate was 14.1% (95% C.I. 11.8e16.4). Thrombolysis before surgery did not result in a significant reduction of the number of amputations, compared with surgery (thrombectomy and bypass) alone. The mean primary patency rates of the bypasses at 1, 3 and 5 years were 79%, 77% and 74%, respectively, in the 'thrombolysis' group and 71% (P Z 0.026), 54% (P Z 0.164) and 45% (P Z 0.249) in the 'thrombectomy' group. No distinction could be made regarding secondary patency and limb-salvage rates between the groups owing to insufficient data.
Annals of Vascular Surgery, 2012
Background: Aim of this study was to retrospectively compare perioperative (<30 days) and 2year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience. Methods: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by c 2 text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by KaplaneMeier curves, and differences in the two groups were assessed by log-rank test.