1
|
Pomatto S, Faggioli G, Pini R, Ficarelli I, Pini A, Angherà C, Rocchi C, Caputo S, Vacirca A, Ruotolo C, Gargiulo M. Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm. World J Emerg Surg 2023; 18:49. [PMID: 37838652 PMCID: PMC10576300 DOI: 10.1186/s13017-023-00514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/21/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Popliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. Few data are available in the literature about the treatment results in these scenarios. The aim of the present study was to evaluate an 11-year multicenter experience in the urgent treatment of PAAs. METHODS All symptomatic PAAs surgically treated in two vascular centers between 2010 and 2021 were retrospectively analyzed. In the postoperative period periodical clinical and Duplex-Ultrasound evaluation were performed. The evaluated endpoint was the outcome of urgent PAAs treatment according to their clinical presentation. Statistical analysis was performed by Kaplan-Meier log-rank evaluation and multivariable Cox regression tests. RESULTS Sixty-six PAAs needed an urgent repair. Twelve (18%) patients had a PAA rupture and 54 (82%) had an acute limb ischemia (ALI) due to either distal embolization or acute thrombosis. Patients with ALI underwent bypass surgery in 51 (95%) cases, which was associated with preoperative thrombolysis in 18 (31%) cases. A primary major amputation was performed in 3 (5%) cases. The mean follow-up was 52 ± 21 months with an overall 5-year limb salvage of 83 ± 6%. Limb salvage was influenced only by the number of patent tibial arteries (pTA) [5-years limb salvage 0%, 86 ± 10%, 92 ± 8% and 100% in case of 0, 1, 2 or 3 pTA, respectively (P = .001)]. An independent association of number of pTA and limb loss was found [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03-0.6), P = .001]. Overall 5-year survival was 71 ± 7%. Ruptured PAAs were associated with lower 5-year survival compared with the ALI group (48 ± 2% vs. 79 ± 7%, P = .001). The number of pTA (33 ± 20%, 65 ± 10%, 84 ± 10% and 80 ± 10% for 0, 1, 2 and 3 pTA, respectively, P = .001) and the thrombolysis (94 ± 6% vs. 62 ± 10%, P = .03) were associated with higher survival in patients with ALI. There was an independent association of number of pTA and long-term survival [HR 0.15 (95% CI 0.03-0.8), P = .03]. CONCLUSIONS PAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and it is associated with lower long-term survival. ALI can benefit from thrombolysis, and long-term limb salvage and survival are associated with the number of pTA.
Collapse
Affiliation(s)
- Sara Pomatto
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Gianluca Faggioli
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Ilaria Ficarelli
- Division of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131, Naples, Italy
| | - Alessia Pini
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Cecilia Angherà
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Cristina Rocchi
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Stefania Caputo
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Andrea Vacirca
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Carlo Ruotolo
- Division of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131, Naples, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna "Alma Mater Studiorum" - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| |
Collapse
|
2
|
Martelli E, Enea I, Zamboni M, Federici M, Bracale UM, Sangiorgi G, Martelli AR, Messina T, Settembrini AM. Focus on the Most Common Paucisymptomatic Vasculopathic Population, from Diagnosis to Secondary Prevention of Complications. Diagnostics (Basel) 2023; 13:2356. [PMID: 37510100 PMCID: PMC10377859 DOI: 10.3390/diagnostics13142356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Middle-aged adults can start to be affected by some arterial diseases (ADs), such as abdominal aortic or popliteal artery aneurysms, lower extremity arterial disease, internal carotid, or renal artery or subclavian artery stenosis. These vasculopathies are often asymptomatic or paucisymptomatic before manifesting themselves with dramatic complications. Therefore, early detection of ADs is fundamental to reduce the risk of major adverse cardiovascular and limb events. Furthermore, ADs carry a high correlation with silent coronary artery disease (CAD). This study focuses on the most common ADs, in the attempt to summarize some key points which should selectively drive screening. Since the human and economic possibilities to instrumentally screen wide populations is not evident, deep knowledge of semeiotics and careful anamnesis must play a central role in our daily activity as physicians. The presence of some risk factors for atherosclerosis, or an already known history of CAD, can raise the clinical suspicion of ADs after a careful clinical history and a deep physical examination. The clinical suspicion must then be confirmed by a first-level ultrasound investigation and, if so, adequate treatments can be adopted to prevent dreadful complications.
Collapse
Affiliation(s)
- Eugenio Martelli
- Department of General and Specialist Surgery, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Sciences, 8 Via di Sant'Alessandro, 00131 Rome, Italy
- Division of Vascular Surgery, Department of Cardiovascular Sciences, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Iolanda Enea
- Emergency Department, S. Anna and S. Sebastiano Hospital, Via F. Palasciano, 81100 Caserta, Italy
| | - Matilde Zamboni
- Division of Vascular Surgery, Saint Martin Hospital, 22 Viale Europa, 32100 Belluno, Italy
| | - Massimo Federici
- Department of Systems Medicine, School of Medicine and Surgery, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy
| | - Umberto M Bracale
- Division of Vascular Surgery, Federico II Polyclinic, Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, 5 Via S. Pansini, 80131 Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, School of Medicine and Surgery, University of Rome Tor Vergata, 1 Viale Montpellier, 00133 Rome, Italy
| | - Allegra R Martelli
- Faculty-Medicine & Surgery, Campus Bio-Medico University of Rome, 21 Via À. del Portillo, 00128 Rome, Italy
| | - Teresa Messina
- Division of Anesthesia and Intensive Care of Organ Transplants, Umberto I Polyclinic University Hospital, 155 Viale del Policlinico, 00161 Rome, Italy
| | - Alberto M Settembrini
- Division of Vascular Surgery, Maggiore Polyclinic Hospital Ca' Granda IRCCS and Foundation, 35 Via Francesco Sforza, 20122 Milan, Italy
| |
Collapse
|
3
|
de Donato G, Pasqui E, Galzerano G, Anzaldi MG, Cappelli A, Palasciano G. The Combination of Vacuum-Assisted Thromboaspiration and Covered Stent Graft for Acute Limb Ischemia due to Thromboembolic Complications of Popliteal Aneurysm. Ann Vasc Surg 2023; 89:232-240. [PMID: 36174918 DOI: 10.1016/j.avsg.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We present a standardized protocol of endovascular revascularization for patients with acute limb ischemia due to popliteal artery aneurysm (PAA) thromboembolic complication, based on the combination of vacuum-assisted thromboaspiration to improve tibiopedal outflow and covered stent graft to exclude the PAA. METHODS All patients with a diagnosis of PAA complicated by thromboembolic events undergoing total endovascular rescue were prospectively enrolled in a dedicated database from November 2018 to November 2021. To assess vessel patency, the TIPI (Thromboaspiration In Peripheral Ischemia) classification was used. The primary end point was the primary technical success (at least one tibial vessel with a TIPI flow of 2 or 3). The 30-day overall mortality and amputation rates were considered as secondary end points. Patients' overall survival, limb salvage, freedom from reocclusion and reinterventions were reported as secondary late outcomes using Kaplan-Meier method. RESULTS Seventeen male patients were enrolled with a mean age of 75.7 ± 9 years. Rutherford grading score was IIa in 52.9% (9/17) and IIb in 47.1% (8/17). PAA mean diameter was 37.4 ± 11.2 mm. All patients had tibial arteries involvement, and in 9 cases (52.9%) there was also the occlusion of the PAA. Mechanical thrombectomy with Indigo/Penumbra thromboaspiration system was used in all patients. PAAs were excluded using one or more VIABAHN covered endografts (range 1-3 pieces). Technical success was achieved in 94.1%. Fasciotomy was performed in 1 case (5.9%). Mortality and amputation rates at 30-day follow-up were respectively 0% and 5.9%. Survival rates at 6, 12, and 24 months were respectively 94.1%, 86.3%, and 67.9%. Secondary patency was achieved in all cases (100%). Freedom from reintervention was 80.4%, 65.8%, and 54.8% at 6-, 12-, and 24-month follow-up. Limb salvage was 88.2% at 6-, 12-, and 24-month follow-up, respectively. CONCLUSIONS Although preliminary, our experience of total endovascular rescue for complicated PAA with thromboembolic events highlighted promising rates of limb salvage at 30 days after intervention. The total endovascular approach seems able to maximize tibiopedal outflow offering an interesting strategy in limb salvage.
Collapse
Affiliation(s)
- Gianmarco de Donato
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy.
| | - Edoardo Pasqui
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy
| | - Giuseppe Galzerano
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy
| | - Manfredi Giuseppe Anzaldi
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy
| | - Alessandro Cappelli
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy
| | - Giancarlo Palasciano
- Department of Medicine, Surgery, and Neuroscience, Vascular Surgery Unit, University of Siena, Siena, Italy
| |
Collapse
|
4
|
Xiao X, Feng R, Wang M, Sun H, Jing T, Su L, Fan Y, Hu Z, Wang S, Wang S. Comparisons of outcomes of open surgery versus endovascular intervention for thrombotic popliteal artery aneurysm with acute lower limb ischemia: a systematic review. BMC Surg 2022; 22:398. [PMCID: PMC9673418 DOI: 10.1186/s12893-022-01843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Thrombotic popliteal artery aneurysm (PAA) with acute lower limb ischemia (ALI) is a serious disease leading to amputation. The choice of emergency procedures is not clearly defined, and the difference in therapeutic efficiency between open surgery and endovascular intervention is still unclear. Method We conducted a comprehensive search through PubMed, Wiley Online Library and ScienceDirect. According to the predefined inclusion and exclusion criteria, eligible articles were screened out, and all relevant data were extracted for further analysis. Our study was designed and developed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We critically assessed all included articles by Joanna Briggs Institute (JBI) Critical Appraisal Checklists and the Methodological Index for Non-Randomized Studies (MINORS). Result A total of 29 articles (1338 patients/1387 limbs) were included in the study. After a 1-year follow-up, the primary patency rate of the open surgery group was significantly lower than that of the endovascular intervention group (72.65 vs. 81.46%, P = 0.004), but without significant difference in the secondary patency rate (86.19 vs. 86.86%, P = 0.825). The limb salvage rate of the open surgery group was also significantly lower (83.07 vs. 98.25%, P < 0.001). After the 2-year follow-up, the primary patency rate of the open surgery group was still significantly lower (48.57 vs. 59.90%, P = 0.021). Conclusion The outcome of endovascular intervention was better than that of open surgery especially in the 1-year limb salvage rate and primary patency rate at the 1-year and 2-year follow-ups.
Collapse
Affiliation(s)
- Xixi Xiao
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China ,grid.12981.330000 0001 2360 039XZhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China
| | - Ruijia Feng
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China ,grid.12981.330000 0001 2360 039XZhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China
| | - Mingshan Wang
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Hanqi Sun
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China ,grid.12981.330000 0001 2360 039XZhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China
| | - Tianzhen Jing
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China ,grid.12981.330000 0001 2360 039XZhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080 China
| | - Lianhua Su
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - You Fan
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Zuojun Hu
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Shenming Wang
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Siwen Wang
- grid.12981.330000 0001 2360 039XDepartment of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd road, Yuexiu District, Guangzhou, 510080 Guangdong China
| |
Collapse
|
5
|
Abstract
Acute limb ischemia (ALI) is a vascular emergency associated with high rates of limb loss and mortality. Management of these patients is challenging given the severe systemic illness resulting from tissue ischemia and the high incidence of preexisting comorbid conditions and underlying peripheral arterial disease. Expeditious diagnosis, anticoagulation, and revascularization are of utmost importance in reducing morbidity. Revascularization may be accomplished using open, endovascular, or hybrid techniques. Approach to revascularization depends on the severity of ischemia, location of occlusion, cause, chance of recovery, comorbidities, and available resources.
Collapse
Affiliation(s)
- Elizabeth G King
- Division of Vascular & Endovascular Surgery, Boston University School of Medicine 85 East Concord Street, Suite 3000, Boston, MA 02118, USA
| | - Alik Farber
- Division of Vascular & Endovascular Surgery, Boston University School of Medicine 85 East Concord Street, Suite 3000, Boston, MA 02118, USA.
| |
Collapse
|
6
|
ARE SMALL POPLITEAL ANEURYSM SO INNOCENT? Ann Vasc Surg 2022; 84:265-269. [PMID: 34995741 DOI: 10.1016/j.avsg.2021.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We recently recorded 5 lower limb ischemia related to a small (diameter≤20 mm) popliteal artery aneurysm (PAA) thrombosis hence we performed a retrospective data analysis on small symptomatic PAA management from our database. METHODS We performed a retrospective cohort study on 48 acute leg ischemia from aneurysm's thrombosis. All of them underwent surgical distal thrombectomy and bypass creation. Patients were divided into two different cohorts: GROUP A (diameter ≥20mm) and GROUP B (diameter ≤20 mm). Differences in terms of the limb salvage (end-point: the amputation rate) was analyzed and considered significative for p≤0.05. Secondary objectives were: vessel runoff recovery and patency rate. Adverse events were collected at 12 and 24 months postoperative. RESULTS Two year overall amputation rate was: 22.9% (11/48); 21.8% (7/32) in GROUP A and 25% (4/16) in GROUP B (RR:0.87, CI:0.29-2.55, p.80). The mean age was 68±13 years, No statistically significant differences were identified in term of primary and secondary patency (RR:0.95, CI:0.55-1.6, p.85 and (RR:0.95, CI:0.53-1.7, p.88 respectively) no differences were found in terms of comorbidities. Patients' follow-up ranged from 8 to 36 months. . In 90% of those amputated patients, the length of ischemia exceeded 4 days.Amputation rate was correlated with one runoff vessel recovery, only. CONCLUSION According these results small PAA are not as innocent as it is often presumed and was associated with not negligible incidence of limb loss due to thrombosis or distal embolizations also if compared to larger aneurysm. The immediate surgery is mandatory also when the ischemia exceeds 2 days.
Collapse
|
7
|
Jergovic I, Cheesman MA, Siika A, Khashram M, Paris SM, Roy J, Hultgren R. Natural history, growth rates, and treatment of popliteal artery aneurysms. J Vasc Surg 2021; 75:205-212.e3. [PMID: 34500029 DOI: 10.1016/j.jvs.2021.07.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The natural history of a cohort of patients monitored for popliteal artery aneurysms (PAAs) has not been well described. A prevailing uncertainty exists regarding the optimal surveillance strategies and timing of treatment. The primary aim of the present study was to describe the care trajectory of all patients with PAAs identified at two tertiary vascular centers, both in surveillance and eventually treated. The secondary aim was to define the PAA growth rates. METHODS A retrospective, multicenter cohort study was performed of all patients with PAAs at two vascular centers in two countries (Sweden, 2009-2016; New Zealand, 2009-2017). Data were collected from electronic medical records regarding the comorbidities, treatment, and outcomes and analyzed on a patient- and extremity-specific level. Treatment was indicated at the occurrence of emergent symptoms or considered at a PAA threshold of >2 cm. The PAAs were divided into small (≤15 mm) and large (>15 mm) aneurysms. The mean surveillance follow-up was 5.1 years. RESULTS Most of the 241 identified patients (397 limbs) with a diagnosis of PAAs had bilateral aneurysms (n = 156). Most patients were treated within the study period (163 of 241; 68%), and one half of the diagnosed extremities with PAA had been treated (54%; 215 of 397). Among those who had undergone elective repair, treatment had usually occurred within 1 year after the diagnosis (66%; 105 of 158). More small PAAs were detected in the group that had required emergent repair compared with elective repair (6 of 57 [11%] vs 12 of 158 [8%]; P < .001). No differences were found in the mean diameters between the elective and emergent groups (30.1 mm vs 32.2 mm; P = .39). Growth was recorded in 110 PAAs and on multivariate analysis was associated with a larger index diameter (odds ratio, 1.138; 95% confidence interval, 1.040-1.246; P = .005) and a concurrent abdominal aortic aneurysm (odds ratio, 2.553; 95% confidence interval, 1.018-6.402; P = .046). CONCLUSIONS The present cohort of patients represented a true contemporary clinical setting of monitored PAAs and showed that most of these patients will require elective repair, usually within 1 year. The risk of emergent repair is not negligible for patients with smaller diameter PAAs. However, the optimal selection strategy for preventive early repair is still unknown. Future morphologic studies are needed to support the development of individualized surveillance protocols.
Collapse
Affiliation(s)
- Iva Jergovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus A Cheesman
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Antti Siika
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of Auckland, New Zealand
| | - Simon M Paris
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Wu L, Green P, Gorenchtein M, Bulacan CF, Aranoff N, Ratcliffe JA. Endovascular treatment of a popliteal artery aneurysm via transpedal approach: A case report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:170-173. [PMID: 34303624 DOI: 10.1016/j.carrev.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Popliteal artery aneurysm (PAA) has been increasingly treated with endovascular intervention in recent years. However, whether transpedal access can be utilized to treat PAA has not been widely reported. We report a case of successful treatment of a PAA with a covered stent via retrograde transpedal approach in an 80-year male with prohibitive surgical risk who initially failed antegrade approach. This case demonstrates the feasibility of treating PAA via a retrograde transpedal access in selected patients.
Collapse
Affiliation(s)
- Lingling Wu
- Department of Medicine, Mount Sinai Morningside Hospital, New York, NY, USA.
| | - Philip Green
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA; Sorin Medical Group, New York, NY, USA
| | - Mike Gorenchtein
- Department of Medicine, Mount Sinai Morningside Hospital, New York, NY, USA
| | | | - Nicole Aranoff
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA; Sorin Medical Group, New York, NY, USA
| | - Justin A Ratcliffe
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA; Sorin Medical Group, New York, NY, USA
| |
Collapse
|
9
|
Tayfur K, Bademci MŞ. Popliteal artery aneurysms treatments: early midterm results of the use of endovascular stent grafts. Turk J Med Sci 2021; 51:1106-1114. [PMID: 33356034 PMCID: PMC8283443 DOI: 10.3906/sag-2005-263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background/aim Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data. Material and methods A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel tortuosity, the presence and degree of thrombus, and diameter in the healthy landing zone and to visualize tibioperoneal vascular structures. A Viabahn stent graft was inserted in all patients. Results 57 patients (90.5%) were males with a mean age of 76.35
±
7 years. 24 patients (38.1%) were symptomatic, while 11 patients (17.5%) had a concomitant abdominal aortic aneurysm (AAA). The mean follow-up period was 46.05
±
25.01 months. The primary patency rate was 79.3%. A graft thrombosis was observed in 13 patients (20.6%) during a mean follow-up period of 8.31
±
5.91 months. The number of distal arteries was significantly lower in the patients with thrombosis than those without. Conclusions Endovascular treatment of PAA using stentgrafts is safe in selected cases. However, it is reasonable to avoid endovascular treatment due to an increased risk for thrombosis in patients with a low number of patent distal arteries or impaired distal flow.
Collapse
Affiliation(s)
- Kaptanıderya Tayfur
- Department of Cardiovascular Surgery, Faculty of Medicine, Ordu University, Ordu Training and Research Hospital, Ordu, Turkey
| | - Mehmet Şenel Bademci
- Department of Cardiovascular Surgery, Faculty of Medicine, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
10
|
Farber A, Angle N, Avgerinos E, Dubois L, Eslami M, Geraghty P, Haurani M, Jim J, Ketteler E, Pulli R, Siracuse JJ, Murad MH. The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms. J Vasc Surg 2021; 75:109S-120S. [PMID: 34023430 DOI: 10.1016/j.jvs.2021.04.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms (PAAs) leverage the work of a panel of experts chosen by the Society for Vascular Surgery to review the current world literature as it applies to PAAs to extract the most salient, evidence-based recommendations for the treatment of these patients. These guidelines focus on PAA screening, indications for intervention, choice of repair strategy, management of asymptomatic and symptomatic PAAs (including those presenting with acute limb ischemia), and follow-up of both untreated and treated PAAs. They offer long-awaited evidence-based recommendations for physicians taking care of these patients.
Collapse
Affiliation(s)
- Alik Farber
- Boston Medical Center, Boston University School of Medicine, Boston, Mass.
| | | | - Efthymios Avgerinos
- Clinic of Vascular and Endovascular Surgery, Athens Medical Group, University of Athens, Athens, Greece
| | - Luc Dubois
- London Health Sciences Center, Western University, London, Ontario, Canada
| | - Mohammad Eslami
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pa
| | | | - Mounir Haurani
- The Ohio State University Medical Center, Columbus, Ohio
| | - Jeffrey Jim
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn
| | - Erika Ketteler
- New Mexico Veterans Affairs Health Care System, Albuquerque, NM
| | | | - Jeffrey J Siracuse
- Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn
| |
Collapse
|
11
|
Klaudikace u mladých pacientů. COR ET VASA 2020. [DOI: 10.33678/cor.2020.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Della Schiava N, Naudin I, Bordet M, Boudjelit T, Moia A, Arsicot M, Tresson P, Lermusiaux P, Millon A. Intra-arterial thrombolysis in acute popliteal artery occlusion is a safe and effective technique reducing the rate of open surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:745-751. [PMID: 32241089 DOI: 10.23736/s0021-9509.20.11121-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute popliteal artery occlusion is a frequent clinical entity with a risk of major amputation. Several attitudes are possible and treatment is not standardized. The purpose of this study is to demonstrate safety and effectiveness of intra-arterial thrombolysis in acute popliteal artery occlusion. METHODS This is a retrospective analysis of a prospective database of patients treated by intra-arterial thrombolysis for acute lower-limb ischemia due to popliteal artery occlusion between 2001 and 2014.The primary endpoint was technical and clinical success. Etiologies and etiologic treatment, amputation-free survival, in-hospital mortality and bleeding complications rates were secondary endpoints. RESULTS Seventy-one patients, with a mean 6-day-old ischemic time before thrombolysis, were analyzed. Technical and clinical success was 90% and 87% respectively. Etiology was embolic in 33 patients (cardiac N.=14, aortic=6, unknown=13) and thrombotic in 38 (atheromatous N.=19, entrapment N.= 4, popliteal aneurysm N.=11, Buerger N.=2, thrombophilia N.=1, hyperhomocysteinemia N.=1). Survival and amputation-free survival at 30 days were 97% and 94% respectively. There were no major bleeding complications. CONCLUSIONS Intra-arterial thrombolysis of acute popliteal artery occlusion is an effective technique which reduces the rate of open surgery. The risk of bleeding complications is very low.
Collapse
Affiliation(s)
- Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France - .,University Claude Bernard Lyon 1, Lyon, France -
| | - Iris Naudin
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Marine Bordet
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Tarek Boudjelit
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France
| | - Alessia Moia
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France
| | - Matthieu Arsicot
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France
| | - Philippe Tresson
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France
| | - Patrick Lermusiaux
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
13
|
Pfabe FP. [The Treatment of Aneurysms of the Extremities Arteries - a Systematic Overview - New Therapies for Isolated Iliac Artery Aneurysm Employing a New Classification]. Zentralbl Chir 2020; 145:456-466. [PMID: 31931546 DOI: 10.1055/a-1027-7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.
Collapse
Affiliation(s)
- Frank-Peter Pfabe
- Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark GmbH, Schwedt, Deutschland
| |
Collapse
|
14
|
Effect of Intra-operative Intra-arterial Thrombolysis on Long Term Clinical Outcomes in Patients with Acute Popliteal Artery Aneurysm Thrombosis. Eur J Vasc Endovasc Surg 2020; 59:255-264. [PMID: 31917126 DOI: 10.1016/j.ejvs.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 09/30/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Acute lower limb ischaemia (ALI) as a result of popliteal artery aneurysm (PAA) thrombosis represents a significant problem. The aim of this study was to investigate outcome of intra-operative intra-arterial thrombolysis in the treatment of acute ischaemia due to PAA thrombosis in terms of major adverse limb events (MALE), overall survival, and intrahospital complications, especially those associated with bleeding. METHODS A total of 156 patients with Rutherford grade IIa and IIb acute ischaemia resulting from PAA thrombosis were admitted between 1 January 2011 and 1 January 2017. The patients were divided into two groups, those who underwent additional treatment with intra-operative intra-arterial thrombolysis (20 patients), and those who did not (136 patients). By using covariables from baseline and angiographic characteristics, a propensity score was calculated for each patient. Each patient who underwent intra-operative thrombolysis was matched to four patients from the non-thrombolysis group. Thus, comparable patient cohorts (20 in the thrombolysis and 80 in the non-thrombolysis group) were identified for further analysis. The primary end point was MALE and the secondary endpoint all cause mortality. RESULTS After a median follow up of 55 months, the estimated MALE rate was significantly lower in the thrombolysis group (30% vs. 65%, chi square = 10.86, p < .001, log rank test). Also, patients in the thrombolysis group had a significantly lower mortality rate (20% vs. 42.65%, chi square = 3.65, p = .05, log rank test). The thrombolysis group had wound/haematoma related interventions performed more commonly (25% in thrombolysis vs 8%, in non-thrombolysis group), but the difference was not significant (p=.013). There were no cases of major (intracranial and gastrointestinal) bleeding in either group. CONCLUSION The data suggest that intra-operative thrombolysis in the treatment of selected patients with ALI due to PAA thrombosis has long term MALE and overall survival benefits, without a significant risk of major, life threatening bleeding complications.
Collapse
|
15
|
Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES, Hinchliffe R, Jongkind V, Koelemay MJW, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC, Esvs Guidelines Committee, de Borst GJ, Chakfé N, Kakkos SK, Koncar I, Lindholt JS, Tulamo R, Vega de Ceniga M, Vermassen F, Document Reviewers, Boyle JR, Mani K, Azuma N, Choke ETC, Cohnert TU, Fitridge RA, Forbes TL, Hamady MS, Munoz A, Müller-Hülsbeck S, Rai K. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2019; 59:173-218. [PMID: 31899099 DOI: 10.1016/j.ejvs.2019.09.006] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
16
|
Tetsi L, Charles AL, Georg I, Goupilleau F, Lejay A, Talha S, Maumy-Bertrand M, Lugnier C, Geny B. Effect of the Phosphodiesterase 5 Inhibitor Sildenafil on Ischemia-Reperfusion-Induced Muscle Mitochondrial Dysfunction and Oxidative Stress. Antioxidants (Basel) 2019; 8:antiox8040093. [PMID: 30959961 PMCID: PMC6523910 DOI: 10.3390/antiox8040093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
Lower-limb ischemia-reperfusion (IR) is frequent and associated with significant morbidity and mortality. Phosphodiesterase 5 inhibitors demonstrated antioxidant and beneficial effects in several organs submitted to IR, but their effects on muscle mitochondrial functions after lower-limb IR are unknown. Unilateral hindlimb IR (2 h tourniquet followed by 2 h reperfusion) without or with sildenafil (1mg/kg ip 30 minutes before ischemia) was performed in 18 mice. Maximal oxidative capacity (VMax), relative contribution of the mitochondrial respiratory chain complexes, calcium retention capacity (CRC)—a marker of apoptosis—and reactive oxygen species (ROS) production were determined using high-resolution respirometry, spectrofluorometry, and electron paramagnetic resonance in gastrocnemius muscles from both hindlimbs. IR significantly reduced mitochondrial VMax (from 11.79 ± 1.74 to 4.65 ± 1.11 pmol/s*mg wet weight (ww), p < 0.05, −50.2 ± 16.3%) and CRC (from 2.33 ± 0.41 to 0.84 ± 0.18 µmol/mg dry weight (dw), p < 0.05; −61.1 ± 6.8%). ROS tended to increase in the ischemic limb (+64.3 ± 31.9%, p = 0.08). Although tending to reduce IR-related ROS production (−42.4%), sildenafil failed to reduce muscle mitochondrial dysfunctions (−63.3 ± 9.2%, p < 0.001 and −55.2 ± 7.6% p < 0.01 for VMax, and CRC, respectively). In conclusion, lower limb IR impaired skeletal muscle mitochondrial function, but, despite tending to reduce ROS production, pharmacological preconditioning with sildenafil did not show protective effects.
Collapse
Affiliation(s)
- Liliane Tetsi
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
| | - Anne-Laure Charles
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
| | - Isabelle Georg
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
| | - Fabienne Goupilleau
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
| | - Anne Lejay
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
- Hôpitaux Universitaires de Strasbourg, Service de Physiologie et d'Explorations Fonctionnelles, 67000 Strasbourg, France.
- Hôpitaux Universitaires de Strasbourg, Service de Chirurgie vasculaire et de transplantation rénale, 67000 Strasbourg, France.
| | - Samy Talha
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
- Hôpitaux Universitaires de Strasbourg, Service de Physiologie et d'Explorations Fonctionnelles, 67000 Strasbourg, France.
| | - Myriam Maumy-Bertrand
- IRMA, équipe MoCo et LabEx IRMIA, 7 rue René Descartes, 67084 Strasbourg CEDEX, France.
| | - Claire Lugnier
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
| | - Bernard Geny
- Unistra, Fédération de Médecine Translationnelle, Equipe d'Accueil 3072, « Mitochondrie, Stress oxydant et Protection Musculaire », Institut de Physiologie, 67000 CEDEX, France.
- Hôpitaux Universitaires de Strasbourg, Service de Physiologie et d'Explorations Fonctionnelles, 67000 Strasbourg, France.
| |
Collapse
|
17
|
Jungi S, Kuemmerli C, Kissling P, Weiss S, Becker D, Schmidli J, Wyss TR. Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm. Eur J Vasc Endovasc Surg 2019; 57:393-398. [DOI: 10.1016/j.ejvs.2018.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/28/2018] [Indexed: 11/25/2022]
|
18
|
Fioranelli A, Carpentieri EA, Wolosker N, Castelli V, Caffaro RA. Rupture of Thrombosed Popliteal Aneurysm: A Case Report. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2017.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
19
|
Del Tatto B, Lejay A, Meteyer V, Roussin M, Georg Y, Thaveau F, Geny B, Chakfe N. Open and Endovascular Repair of Popliteal Artery Aneurysms. Ann Vasc Surg 2018; 50:119-127. [PMID: 29501897 DOI: 10.1016/j.avsg.2018.01.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/29/2017] [Accepted: 01/06/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to report midterm outcomes of open repair (OR) or endovascular repair (ER) of popliteal artery aneurysms (PAAs) and assess if outcomes of patients have changed in the endovascular era. METHODS This monocentric and retrospective study included all consecutive patients treated for PAA between January 2004 and December 2016. Before 2010, all patients underwent OR, but ER was available since 2010, and the choice between OR or ER was made on the basis of clinical presentation and preoperative morphological assessment. Survival, primary patency, primary-assisted patency, secondary patency, and limb salvage rates were assessed regarding the surgical way of treatment (OR or ER) or regarding the period of time (before 2010 or since 2010). RESULTS A total of 153 PAA were treated in 126 patients (103 limbs in OR and 50 limbs in ER). Mean follow-up was 3.8 years. Five-year survival was 97.7% for OR and 88.7% for ER. Five-year primary patency was 77.8% and 29.5% for OR and ER, respectively, primary-assisted patency 85.0% and 49.7%, respectively, and secondary patency 92.8% and 79.6%, respectively. Five-year limb salvage was 89.5% for OR and 87.9% for ER. No outcome difference was observed between patients who underwent surgery before or after ER was available. CONCLUSIONS Results of OR and ER in the setting of PAA are satisfactory. Outcomes of patients did not change in the endovascular era.
Collapse
Affiliation(s)
- Benjamin Del Tatto
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Vincent Meteyer
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mathieu Roussin
- Department of Cardiovascular Surgery, Hôpital Mercy, Metz, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|
20
|
Wrede A, Wiberg F, Acosta S. Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm. Vasc Endovascular Surg 2017; 52:115-123. [DOI: 10.1177/1538574417742762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Open repair (OR) for popliteal artery aneurysm (PAA) has recently been challenged by endovascular repair (ER) as the primary choice of treatment. The aim of the present study was to evaluate time trends in treatment modality and compare outcomes between OR and ER among electively operated patients after start of screening in 2010 for abdominal aortic aneurysm (AAA), a disease highly associated with PAA. Methods: Between January 1, 2009, and April 30, 2017, 102 procedures and 36 acute and 66 elective repairs for PAA were identified. Results: Over time, a trend ( P = .089) for an increasing elective to acute repair ratio of PAA and an increase in elective ER to OR ratio ( P = .003) was found. Among electively repaired PAAs, the ER group was older ( P = .047) and had a higher ankle–brachial index (ABI; P = .044). The ER group had fewer wound infections ( P = .003), fewer major bleeding complications ( P = .046), and shorter in-hospital stay ( P < .001). After 1 year of follow-up, the ER group had a higher rate of major amputations ( P = .037). Amputation-free survival at the end of follow-up did not differ between groups ( P = .68). Among the 17 patients with PAA eligible for AAA screening, 4 (24%) were diagnosed with PAA through the screening program of AAA. Conclusion: The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.
Collapse
Affiliation(s)
- Axel Wrede
- These authors contributed equally to this work
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiothoracic and Vascular Surgery, Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Frans Wiberg
- These authors contributed equally to this work
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiothoracic and Vascular Surgery, Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiothoracic and Vascular Surgery, Vascular Center, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
21
|
Results of Infrainguinal Bypass in Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2016; 51:824-30. [DOI: 10.1016/j.ejvs.2016.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/19/2016] [Indexed: 11/19/2022]
|
22
|
Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease. Circulation 2016; 133:997-1005. [DOI: 10.1161/circulationaha.115.019355] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022]
|
23
|
von Stumm M, Teufelsbauer H, Reichenspurner H, Debus ES. Two Decades of Endovascular Repair of Popliteal Artery Aneurysm--A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 50:351-9. [PMID: 26138062 DOI: 10.1016/j.ejvs.2015.04.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND Over the last two decades endovascular repair (EVR) of popliteal artery aneurysms has emerged as a treatment alternative to conventional open surgical repair (OSR). The aim of this review was to evaluate the safety and efficiency of each repair method, comparing the following outcomes after EVR and OSR: (i) primary patency; (ii) operating time; (iii) length of hospital stay; (iv) peri-operative complications; (v) limb salvage; and (vi) patient survival. METHODS The PubMed and Cochrane Central Register of Controlled Trials were searched for publications that compared outcomes after EVR and OSR (last search November 2014). Randomized controlled trials (RCTs), prospective and retrospective observational cohort studies were included. The quality of studies was evaluated using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random effect models were employed to estimate odds ratios (ORs), mean differences, and hazard ratios (HRs). RESULTS One RCT combined with a prospective cohort study and four retrospective cohort studies with an overall total of 652 cases (236 EVR, 416 OSR) were identified. GRADE quality of evidence was low or very low for all outcomes. After a median follow up of 33 months, patients who received EVR showed equal primary patency rates to patients who received OSR (HR 1.46, 95% confidence interval [CI] 0.92-2.33). Lengths of operation and hospitalization were significantly shorter following EVR; rates of 30 day graft thrombosis (OR 3.16, 95% CI 1.31-7.62) and 30 day re-intervention (OR 2.15, 95% CI 1.02-4.55) were significant higher for patients who received EVR compared with those who received OSR. There was no effect on mortality (OR 2.31, 95% CI 0.37-14.49) or limb loss (OR 0.59, 95% CI 0.16-2.15). CONCLUSION EVR of popliteal artery aneurysm showed mid-term results comparable to open surgery and appears to be a safe alternative to OSR. However, the existing empirical evidence base is too fragmentary to draw firm conclusions. Further research and the introduction of population based registries will be needed to allow reliable evaluation of EVR.
Collapse
Affiliation(s)
- M von Stumm
- Department of Cardiovascular Surgery, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany.
| | - H Teufelsbauer
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - H Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
24
|
Treatment of popliteal artery aneurysms by means of cryopreserved homograft. Ann Vasc Surg 2015; 29:1090-6. [PMID: 26001618 DOI: 10.1016/j.avsg.2015.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Autologous saphenous vein is considered the gold standard conduit in the femoral-popliteal revascularization for popliteal artery aneurysms (PAAs). In several cases, it may be absent or unsuitable for length or diameter and so it may be considered unfit for a conduit. In such patients, a synthetic graft or the endovascular correction can be useful, but results are controversial. In this retrospective case series, we have analyzed the safety and efficacy of the cryopreserved homograft (CHg) as a conduit in the PAA revascularization. METHODS In the period between January 2005 and December 2013, 54 PAAs have been treated with an arterial CHg. Indications to surgery were asymptomatic aneurysm with >25-mm diameter in 30 cases (55.6%), ischemic symptoms in 20 (37%), and compressive symptoms in 4 (7.4%). An urgent treatment was performed in 8 cases (14.8%) for severe ischemic symptoms. All cases have been operated by the same vascular team: a posterior surgical approach was preferred whenever possible (33 cases, 61.1%). All patients received a clinical and radiologic follow-up, and all data were collected in a specific database. A >10-mm diameter increase of the conduit was considered significant for an aneurysmatic degeneration. RESULTS The primary outcomes were complications and reoperation rate, limb salvage, and primary and secondary patency. Secondary outcome was the incidence of aneurysmatic degeneration of the CHg. Mean diameter of the homografts was 6.3 mm (range, 4-8 mm). In the 30-day postoperative period, 7 PAAs (13%) developed a complication: 3 wound infections, 3 graft thrombosis, and 1 anastomotic bleeding. Six cases needed a reoperation: 2 surgical revascularizations, 2 wound debridement, and 1 anastomotic hemostasis; 1 major amputation was necessary for graft failure after the revascularization. Mean follow-up was 34.8 months (range, 1-96). Five cases (9.3%) developed a graft complication with 4 reoperations necessary (7.4%): 2 grafts required a percutaneous transluminal angioplasty for a perigraft stenosis and 2 underwent a femorodistal bypass in CHg for severe ischemic symptoms after CHg occlusion. Another one CHg occlusion was treated conservatively because it was clinically asymptomatic. Primary patency was 96.3%, 93.9%, and 88.3% at 12, 36, and 60 months, respectively; secondary patency was 98.1% at 12, 36, and 60 months. Freedom from amputation resulted in 98.1%. No aneurysmatic degeneration was observed. Univariate and multivariate analysis showed urgent surgery to be independent risk factors for complications, reoperations, and CHg occlusion (P < 0.05). CONCLUSIONS In this retrospective study, the use of CHg showed to be safe and effective in the surgery of PAAs, either in the short or in the long-term follow-up. Urgent surgery can be considered predictive of graft failure. In our experience, CHg can be considered a good alternative conduit to the autologous saphenous vein.
Collapse
|
25
|
Bearse JR. Duplex Ultrasound Findings of Popliteal Artery Aneurysms With Acute Limb Ischemia. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314550250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Popliteal artery aneurysms are rare, but they have the potential to be limb threatening as a result of thrombosis and distal embolization. Duplex sonography may be used to effectively detect popliteal artery aneurysms and determine patency of the runoff arteries. Findings may include dilatation of the popliteal artery during gray-scale imaging with intraluminal heterogeneous echoes indicating the presence of mural thrombus. Abnormal or absent Doppler signals in the more distal arteries with intraluminal heterogeneous echoes may indicate the presence of thrombus, likely from embolization. This case presents the duplex sonography findings of bilateral popliteal artery aneurysms in conjunction with lower extremity acute arterial thrombosis and an abdominal aortic aneurysm.
Collapse
|
26
|
Dorweiler B, Gemechu A, Doemland M, Neufang A, Espinola-Klein C, Vahl CF. Durability of open popliteal artery aneurysm repair. J Vasc Surg 2014; 60:951-7. [DOI: 10.1016/j.jvs.2014.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/10/2014] [Indexed: 11/26/2022]
|
27
|
Huang Y, Gloviczki P, Oderich GS, Duncan AA, Kalra M, Fleming MD, Harmsen WS, Bower TC. Outcomes of endovascular and contemporary open surgical repairs of popliteal artery aneurysm. J Vasc Surg 2014; 60:631-8.e2. [DOI: 10.1016/j.jvs.2014.03.257] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
|
28
|
|
29
|
Ahmed Z, Desai M, Grewal PS, Hamilton G. Operative technique for the treatment of popliteal artery aneurysms. Hippokratia 2014. [DOI: 10.1002/14651858.cd011238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zubir Ahmed
- Guy's and St Thomas' NHS Foundation Trust; General and Transplant Surgery; Level 3, Borough Wing, Guy's Hospital Great Maze Pond London UK SE1 9RT
| | - Mital Desai
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
| | - Perbinder S Grewal
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
| | - George Hamilton
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
| |
Collapse
|
30
|
Lawrence PF, Harlander-Locke MP, Oderich GS, Humphries MD, Landry GJ, Ballard JL, Abularrage CJ. The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history. J Vasc Surg 2014; 59:343-9. [DOI: 10.1016/j.jvs.2013.08.090] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/25/2022]
|
31
|
Acar RD, Sahin M, Kirma C. One of the most urgent vascular circumstances: Acute limb ischemia. SAGE Open Med 2013; 1:2050312113516110. [PMID: 26770694 PMCID: PMC4687773 DOI: 10.1177/2050312113516110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022] Open
Abstract
Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Most of the causes of acute limb ischemia are thrombosis of a limb artery or bypass graft, embolism from the heart or a disease artery, dissection, and trauma. Assessment determines whether the limb is viable or irreversibly damaged. Prompt diagnosis and revascularization by means of catheter-based thrombolysis or thrombectomy and by surgery reduce the risk of limb loss and mortality. Amputation is performed in patients with irreversible damage. Despite urgent revascularization, amputation rate is 10%–15% in patients during hospitalization, mostly above the knee, and mortality within 1 year is 10%–15% due to the coexisting conditions.
Collapse
Affiliation(s)
- Rezzan D Acar
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Muslum Sahin
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cevat Kirma
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
32
|
Long-term Outcome of Endovascular Repair of Popliteal Artery Aneurysm Presents a Credible Alternative to Open Surgery. Cardiovasc Intervent Radiol 2013; 37:914-9. [DOI: 10.1007/s00270-013-0744-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/19/2013] [Indexed: 11/25/2022]
|
33
|
Baril DT, Patel VI, Judelson DR, Goodney PP, McPhee JT, Hevelone ND, Cronenwett JL, Schanzer A. Outcomes of lower extremity bypass performed for acute limb ischemia. J Vasc Surg 2013; 58:949-56. [PMID: 23714364 DOI: 10.1016/j.jvs.2013.04.036] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/09/2013] [Accepted: 04/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. METHODS All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. RESULTS Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function, and respiratory complications. Patients who underwent lower extremity bypass for acute limb ischemia had no difference in rates of graft occlusion (18.1% vs 18.5%; P = .77), but did have significantly higher rates of limb loss (22.4% vs 9.7%; P < .0001) and mortality (20.9% vs 13.1%; P < .0001) at 1 year. On multivariable analysis, acute limb ischemia was an independent predictor of both major amputation (hazard ratio, 2.16; confidence interval, 1.38-3.40; P = .001) and mortality (hazard ratio, 1.41; confidence interval, 1.09-1.83; P = .009) at 1 year. CONCLUSIONS Patients who present with acute limb ischemia represent a less medically optimized subgroup within the population of patients undergoing lower extremity bypass. These patients may be expected to have more complex operations followed by increased rates of perioperative adverse events. Additionally, despite equivalent graft patency rates, patients undergoing lower extremity bypass for acute ischemia have significantly higher rates of major amputation and mortality at 1 year.
Collapse
Affiliation(s)
- Donald T Baril
- University of Massachusetts Medical Center, Worcester, Mass.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Dosluoglu HH. Commentary regarding "A multicentric experience with open surgical repair and endovascular exclusion of popliteal artery aneurysms". Eur J Vasc Endovasc Surg 2013; 45:528-30. [PMID: 23540802 DOI: 10.1016/j.ejvs.2013.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
|
35
|
Abstract
Aneurysms of the popliteal artery are the most common form of peripheral aneurysm with an incidence of 70-80 %. An enlargement of the popliteal artery of more than 50% of the original diameter is defined as a popliteal artery aneurysm and is found mainly in male patients older than 65 years of age. The incidence is 1%, in 50% of cases is bilateral and in up to 50% in association with other large vessel aneurysms (e.g. abdominal aorta). Differential diagnoses are Baker's cyst, cystic adventitial disease, entrapment syndrome and epitheloid hemangioma. One third of all diagnosed popliteal artery aneurysms are asymptomatic incidental findings, whereas two thirds are conspicuous due to symptoms (acute or chronic ischemia, local compression, rupture). The indications for invasive treatment are given for patients with patent aneurysms at a diameter of more than 2 cm or if a thrombus is present within the aneurysm. Symptomatic popliteal artery aneurysms are always an indication for therapy. Treatment strategies are surgical techniques and endovascular interventions, which both have a similar outcome and graft patency in midterm results.
Collapse
Affiliation(s)
- R Ghotbi
- Gefäßchirurgische Klinik, Klinikum München Pasing, Lehrkrankenhaus LMU, München, Deutschland.
| | | |
Collapse
|
36
|
Results of elective and emergency endovascular repairs of popliteal artery aneurysms. J Vasc Surg 2013; 57:1299-305. [PMID: 23375609 DOI: 10.1016/j.jvs.2012.10.112] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). METHODS This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. RESULTS EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P = .14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P = .56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P = .15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. CONCLUSIONS These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.
Collapse
|
37
|
|
38
|
Affiliation(s)
- Mark A Creager
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | | | | |
Collapse
|
39
|
Cross JE, Galland RB. Part one: For the motion asymptomatic popliteal artery aneurysms (less than 3 cm) should be treated conservatively. Eur J Vasc Endovasc Surg 2011; 41:445-8; discussion 449. [PMID: 21453861 DOI: 10.1016/j.ejvs.2011.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J E Cross
- Department of Surgery, Royal Berkshire Hospital, London Road, Reading, Berkshire RG1 5AN, UK
| | | |
Collapse
|
40
|
Cross JE, Galland RB, Hingorani A, Ascher E. Nonoperative versus surgical management of small (less than 3 cm), asymptomatic popliteal artery aneurysms. J Vasc Surg 2011; 53:1145-8. [PMID: 21439460 DOI: 10.1016/j.jvs.2011.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Popliteal artery aneurysms represent a common pathology that vascular surgeons are often confronted with. However, several issues remain incompletely understood, including indications for intervention and optimal methods of treatment. In the following article, our discussants debate the appropriate management of small popliteal artery aneurysms. Further complicating this discussion is the unclear relationship between popliteal artery aneurysm diameter and subsequent complications. Whereas with abdominal aortic aneurysms diameter is linked to rupture risk, it is less clear with popliteal artery aneurysms where complications are more likely to include thrombosis, embolization, and compression whether aneurysm diameter is accurately predictive. Perhaps other anatomic features should be included in our management algorithms? Regardless, our debaters will try to convince us whether small popliteal artery aneurysms warrant repair or not.
Collapse
Affiliation(s)
- Jane E Cross
- Department of Surgery, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | | | | | | |
Collapse
|
41
|
Marsh JP, Turgeon T, Guzman R. Acute limb ischemia following closed reduction of a hip arthroplasty dislocation. Orthopedics 2010; 33:768. [PMID: 20954657 DOI: 10.3928/01477447-20100826-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hip dislocation is a well-described complication of total hip arthroplasty (THA) and dislocation rates are substantially higher following revision hip arthroplasty. Vascular complications following closed reduction of hip dislocations are exceedingly rare, but a high index of suspicion is essential for patients with underlying vascular abnormalities. Popliteal artery aneurysms are the most common peripheral arterial aneurysms with a prevalence of 1% and they should be suspected in patients with prominent popliteal pulses. This article presents a case of an 84-year-old man with a revision total THA who sustained a posterior hip dislocation. The hip was reduced under conscious sedation using the Bigelow technique. The leg was distally neurovascularly intact based on the clinical exam immediately before and after the reduction. Over the next few hours, the foot became progressively ischemic and an urgent computed tomography angiogram revealed bilateral popliteal artery aneurysms with acute thrombosis of the aneurysm on the affected limb. The patient underwent emergent femoral popliteal bypass using a Dacron supported interpositional graft. The majority of the foot was salvaged but the toes eventually became necrotic. Direct compression of the aneurysm during reduction of the hip dislocation in conjunction with transiently decreased blood pressure from conscious sedation likely resulted in a low flow state within the artery leading to thrombosis of the aneurysm. To our knowledge, this is the first reported case of such an event. This case emphasizes the need for a high index of suspicion for vascular injuries following manipulation of limbs with underlying arterial aneurysms. Reduction maneuvers for hip dislocations should be modified to minimize compression of the popliteal fossa in limbs with vascular abnormalities. Serial postreduction neurovascular exams are essential for identification and prompt management of vascular complications.
Collapse
Affiliation(s)
- Jonathan P Marsh
- Section of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | |
Collapse
|
42
|
Gibbons C. Thrombolysis or Immediate Surgery for Thrombosed Popliteal Aneurysms? Eur J Vasc Endovasc Surg 2010; 39:458-9. [DOI: 10.1016/j.ejvs.2009.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
|