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Baccellieri D, Grandi A, Bilman V, Melloni A, Ardita V, Apruzzi L, Melissano G, Chiesa R. Early and mid-term outcomes of open popliteal artery aneurysm repair with prosthetic grafts. J Vasc Surg 2021; 75:1369-1376.e2. [PMID: 34921969 DOI: 10.1016/j.jvs.2021.11.065] [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: 03/02/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study is to assess the early and mid-term outcomes of open surgical repair (OR) for popliteal artery aneurysm (PAA) with prosthetic grafts. MATERIALS AND METHODS The pre-, intra-, and postoperative data of all patients who underwent PAA OR with prosthetic grafts at our Institution between January 2009 and July 2019 were included in a prospectively maintained database which was retrospectively analysed. Primary patency was defined as uninterrupted flow (<50% stenosis) in the graft with no additional procedures performed. Secondary patency was defined as the restoration of graft patency. RESULTS Eighty-two patients underwent OR for 104 PAA (age: 71, 67-78; 82 males) with prosthetic grafts. Seventy-two aneurysms (68%) were asymptomatic. The median diameter was 30mm (24-37). A medial approach was used in 35 aneurysms (34%) while a posterior approach (PA) in 69 (65%). Repairs either consisted of aneurysmectomy or aneurysm ligation without removal with an interposition graft with end-to-end anastomoses. Median operative time was 120 (103-142) minutes. The estimated blood loss (EBL) was 281 (150-281) ml. Only one patient treated by PA sustained a permanent peroneal nerve lesion, and a second patient treated via the same approach needed a surgical revision due to bleeding on postoperative day two. No temporary lesions were recorded. There were no early amputations. No perioperative deaths occurred. The median length of stay (LOS) was 3 (3-4) days. An expanded poly-tetra-flour-ethylene graft was used in 102 cases (98%) and a Dacron graft in the remain two cases (2%). As for the caliber, the 8mm graft was used in 64 cases (62%). Median follow-up was 34.6 (8.5-62.7) months. There was no related mortality. Nineteen PAA underwent reintervention with primary and secondary rate patency of 78% and 88% at three years. The median time to reintervention was 28.3 months. CONCLUSIONS Popliteal artery aneurysms open repair with prosthetic grafts are safe and feasible, with good mid-term results and satisfactory primary and secondary patency at three years.
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Affiliation(s)
- Domenico Baccellieri
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Alessandro Grandi
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy.
| | - Victor Bilman
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Andrea Melloni
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Vincenzo Ardita
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Luca Apruzzi
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, "Vita-Salute" San Raffaele University, Milan, Italy
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Endovascular repair of popliteal artery aneurysms: an Italian multicenter study. Radiol Med 2018; 124:79-85. [DOI: 10.1007/s11547-018-0941-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/04/2018] [Indexed: 11/25/2022]
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3
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Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms. Int Surg 2018. [DOI: 10.9738/intsurg-d-14-00301.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the long-term outcomes of the surgical repair of popliteal artery aneurysms (PAAs), and to analyze the factors associated with graft patency. Between January 1980 and December 2013, 45 limbs were subjected to open surgical repair at Tokyo Medical and Dental Hospital. We retrospectively examined the patients' clinical characteristics, clinical symptoms, and aneurysm-related anatomy. Surgical procedures were performed through a posterior or medial approach using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative mortality, postoperative morbidity, graft patency, and limb salvage. During the study period, 45 limbs (35 patients; mean age, 60 years) underwent open surgical repair. A total of 25 limbs were treated through a posterior approach using 23 autologous vein grafts (AVGs) and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach using 13 AVGs and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at 1, 3, and 5 years were 88.0%, 75.7%, and 75.7%, respectively, and the limb salvage rates at 1, 3, and 5 years were 97.1%, 91.4%, and 91.4%, respectively. In the univariate analysis, the ligation and bypass grafting affected the primary patency rate significantly, and the ePTFE graft was associated with a poor primary patency in the multivariate analysis (hazard ratio, 17.8). The use of resection or endoaneurysmorrhaphy for PAAs and graft interposition with an AVG might be more effective for the open repair of PAAs.
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Mikhaylov IP, Lavrenov VN, Isaev GA, Kokov LS, Trofimova EY. [Ruptures of popliteal artery aneurysms]. Khirurgiia (Mosk) 2018:57-62. [PMID: 29697685 DOI: 10.17116/hirurgia2018457-62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve diagnosis and surgical outcomes in patients with ruptured popliteal artery aneurysm. MATERIAL AND METHODS Eight patients with ruptured popliteal artery aneurysm have undergone surgery for the period from 1999 to 2015 at the Vascular Surgery Department of Sklifosovsky Research Institute for Emergency Care. Incidence of rupture was 2.9% from total number of popliteal artery aneurysm. 7 patients with rupture had signs of lower limb ischemia (acute form grade I in 2 (25%) cases, grade IIA in 1 (12.5%), grade IIB in 1 (12.5%) case, chronic ischemia grade IIB in 2 (25%) patients, grade III in 1 (12.5%) patient). 1 (12,5%) patient had not lower limb ischemia. Preoperatively all patients underwent sonography of lower limb arteries and soft tissues, computed tomography of the same structures was carried out in 3 patients, 5 patients underwent subtraction digital angiography. Presence and dimensions of soft tissues hematoma, arterial perfusion proximally and distally to popliteal artery, aneurysms of contralateral limb and other localizations were assessed. RESULTS Amputations after surgical repair were absent in 6 patients. Five patients were discharged with patent graft, completely compensated blood flow and primary healing of postoperative wound. Severe postoperative complications followed by amputation occurred in 2 patients. One patient died with reperfusion syndrome, hematoma and graft infection, sepsis. CONCLUSION 1) Ruptured popliteal artery aneurysm is extremely rare complication, however it is a formidable event with high risk of amputation and death. 2) Early diagnosis of popliteal artery aneurysm and surgical treatment prior to embolism, thrombosis and rupture are necessary to prevent formidable complications. 3) Timely detection of aneurysms and their complications by general practitioners is extremely low due to rarity and specificity of the disease, presence of various symptoms. It is necessary to popularize knowledge about this disease among general practitioners. 4) Sonography is screening method for differential diagnosis. 5) CT-angiography or subtraction angiography are advisable to assess distal perfusion if patient's state is stable without severe ischemia. 6) Aneurysm repair with popliteal artery replacement should be performed in early period after rupture in order to reduce time of ischemia and to prevent infection of hematoma in view of ischemia and anemia.
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Affiliation(s)
- I P Mikhaylov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - V N Lavrenov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - G A Isaev
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - L S Kokov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - E Yu Trofimova
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
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Cousins RS, Dexter DJ, Ahanchi SS, Cain BC, Powell OM, Ongstad SB, Parikh NM, Panneton JM. Determining patient risk factors associated with accelerated growth of popliteal artery aneurysms. J Vasc Surg 2018; 67:838-847. [DOI: 10.1016/j.jvs.2017.07.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022]
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Bush RL, Bianco CC, Lin PH, Lumsden AB. Endovascular Treatment of an Endoleak Causing Rupture of a Previously Bypassed Popliteal Aneurysm. Vasc Endovascular Surg 2016; 38:257-61. [PMID: 15181508 DOI: 10.1177/153857440403800310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Enlargement of a previously bypassed popliteal aneurysm is rare. However, the possibility exists for persistent aneurysm expansion via geniculate collaterals. The authors report herein a patient who underwent successful endovascular treatment of a ruptured popliteal aneurysm that had been previously bypassed and presumably excluded.
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Affiliation(s)
- Ruth L Bush
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Mousa AY, Beauford RB, Henderson P, Patel P, Faries PL, Flores L, Fogler R. Update on the Diagnosis and Management of Popliteal Aneurysm and Literature Review. Vascular 2016; 14:103-8. [PMID: 16956479 DOI: 10.2310/6670.2006.00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Popliteal artery aneurysms (PAAs) are the most frequent peripheral aneurysm with a significant morbidity if left untreated. Open surgical technique is still considered the gold standard; however the revolution in endovascular repair has proven to be a valid alternative option in selected patients. The role of endovascular treatment in PAA is still considered in its infancy. In addition, the indications for use of endovascular stents as compared to standard open surgery have not yet been fully defined and more studies are warranted to characterize the durability of this technique. This article describes the general principles of the natural history, clinical presentation, and long-term limb salvage and survival outcomes for patients with such aneurysms. It also details the features and results for the devices in current use and highlights the current consensus in the management of PAA.
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Affiliation(s)
- Albeir Y Mousa
- New York Weill Cornell Medical Center, New York, NY, USA.
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8
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Reliability of Ultrasound Diameter Measurements in Patients with a Small Asymptomatic Popliteal Artery Aneurysm: An Intra- and Inter-observer Agreement Study. Eur J Vasc Endovasc Surg 2016; 51:410-4. [PMID: 26804485 DOI: 10.1016/j.ejvs.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In this study the intra- and inter-observer variability of ultrasound measurements of the diameter of the popliteal artery were tested in a group of patients under surveillance for a small (diameter 10-20 mm), asymptomatic popliteal artery aneurysm (PAA). METHODS From a group of patients under ultrasound surveillance for bilateral, asymptomatic PAAs, 13 consecutive patients agreed to participate in the study and provided informed consent. The maximum diameter of the popliteal arteries was assessed by a vascular technologist. The same assessment was repeated by a second vascular technologist, unaware of the results of the first measurement. After a week, this protocol was repeated. The intra- and inter-observer reliability of this measurement was calculated using intra-class correlation coefficients (ICCs) and Bland and Altman plots. RESULTS Of the 10 patients with bilateral and three patients with unilateral PAA, 12 completed the 2 week protocol. A total of 86 measurements were analyzed. The mean diameter of the popliteal arteries was 13.5 ± 3.4 mm. The ICC for the intra-observer reliability of observer 1 was 0.96 (95% CI 0.92-0.99), p < .001 and of observer 2 was 0.98 (95% CI 0.95-0.99), p < .001. The ICC for the inter-observer reliability for the first measurements was 0.96 (95% CI 0.90-0.98), p < .001 and for the second measurements 0.97 (95% CI 0.94-0.99), p < .001. The Bland-Altman plots showed random error, while 95% of the variation was between 0.016 and 0.16, p > .47. The absolute magnitude of the systematic error of both observers was less than 0.135 mm (median 0.00). CONCLUSION Ultrasound measurement of the maximum diameter of the popliteal artery is reproducible; hence, it is suitable for making a clinical treatment decision. Its use for surveillance of small, asymptomatic PAAs is justified.
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Vemulapalli S, Patel MR, Jones WS. Limb Ischemia: Cardiovascular Diagnosis and Management from Head to Toe. Curr Cardiol Rep 2015; 17:611. [DOI: 10.1007/s11886-015-0611-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kropman RH, van Meurs A, Fioole B, Vos JA, van Santvoort HC, van Sambeek M, Moll FL, de Vries JPP. Association of Sex with Long-Term Outcomes after Popliteal Artery Aneurysm Repair. Ann Vasc Surg 2014; 28:338-44. [DOI: 10.1016/j.avsg.2013.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/17/2013] [Accepted: 04/27/2013] [Indexed: 11/24/2022]
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Editor's Choice: Contemporary Treatment of Popliteal Artery Aneurysm in Eight Countries: A Report from the Vascunet Collaboration of Registries. Eur J Vasc Endovasc Surg 2014; 47:164-71. [DOI: 10.1016/j.ejvs.2013.10.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
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12
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Taurino M, Filippi F, Ficarelli R, Fantozzi C, Dito R, Brancadoro D, Rizzo L. Different approaches in popliteal artery aneurysm management. Eur Surg 2013. [DOI: 10.1007/s10353-013-0221-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Tsilimparis N, Dayama A, Ricotta JJ. Open and Endovascular Repair of Popliteal Artery Aneurysms: Tabular Review of the Literature. Ann Vasc Surg 2013; 27:259-65. [DOI: 10.1016/j.avsg.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/23/2012] [Indexed: 11/17/2022]
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14
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Comparison of Early and Midterm Results of Open and Endovascular Treatment of Popliteal Artery Aneurysms. Ann Vasc Surg 2012; 26:809-18. [DOI: 10.1016/j.avsg.2011.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/28/2011] [Accepted: 09/30/2011] [Indexed: 11/22/2022]
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15
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Zaraca F, Ponzoni A, Stringari C, Ebner JA, Giovannetti R, Ebner H. The Posterior Approach in the Treatment of Popliteal Artery Aneurysm: Feasibility and Analysis of Outcome. Ann Vasc Surg 2010; 24:863-70. [DOI: 10.1016/j.avsg.2010.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 04/14/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
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16
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Kropman R, Schrijver A, Kelder J, Moll F, de Vries J. Clinical Outcome of Acute Leg Ischaemia Due to Thrombosed Popliteal Artery Aneurysm: Systematic Review of 895 Cases. Eur J Vasc Endovasc Surg 2010; 39:452-7. [PMID: 20153667 DOI: 10.1016/j.ejvs.2009.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
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17
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Endovascular repair of popliteal aneurysms. J Vasc Surg 2010; 51:1056-60. [DOI: 10.1016/j.jvs.2009.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 09/03/2009] [Accepted: 09/06/2009] [Indexed: 11/22/2022]
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Bisdas T, Paraskevas KI, Pichlmaier M, Wilhelmi M, Haverich A, Teebken OE. Dorsal (Posterior) Versus Medial Approach for the Surgical Repair of Popliteal Artery Aneurysms. Angiology 2010; 61:248-52. [DOI: 10.1177/0003319709355802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The surgical approach-of-choice for the management of popliteal artery aneurysms (PAAs) remains controversial. We compared the results of the medial (MA) and dorsal (posterior) surgical approach (DA). Fifty patients (44 males/6 females; median age [range]: 59 [49-84] years) treated for 58 atherosclerotic PAAs were studied (MA: 29 PAAs; DA: 29 PAAs). The 3-year graft patency rates were higher after DA compared with MA (76% vs 52%, respectively), but the difference was not significant (P = .056). There were no differences between the 2 approaches in amputation, restenosis, reoperation, and wound infection rates. Dorsal approach and the MA may be alternative approaches with similar long-term results. Due to the controversial results reported so far, a meta-analysis may be necessary to establish the surgical approach-of-choice. Future studies should take into account additional factors, other than the surgical technique, when assessing outcome (eg, preoperative statin use, age, and emergency vs routine surgery).
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Affiliation(s)
- Theodosios Bisdas
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Maximilian Pichlmaier
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthias Wilhelmi
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Omke Enno Teebken
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Idelchik GM, Dougherty KG, Hernandez E, Mortazavi A, Strickman NE, Krajcer Z. Endovascular Exclusion of Popliteal Artery Aneurysms With Stent-Grafts: A Prospective Single-Center Experience. J Endovasc Ther 2009; 16:215-23. [PMID: 19456186 DOI: 10.1583/08-2412.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martín-Conejero A, Martínez-López I, Serrano-Hernando F. Aneurisma poplíteo roto resuelto mediante tratamiento endovascular. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)15008-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cinà C, Moore R, Maggisano R, Kucey D, Dueck A, Rapanos T. Endovascular repair of popliteal artery aneurysms with anaconda limbs: Technique and early results. Catheter Cardiovasc Interv 2008; 72:716-24. [DOI: 10.1002/ccd.21706] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Johnson ON, Slidell MB, Macsata RA, Faler BJ, Amdur RL, Sidawy AN. Outcomes of surgical management for popliteal artery aneurysms: An analysis of 583 cases. J Vasc Surg 2008; 48:845-51. [PMID: 18639422 DOI: 10.1016/j.jvs.2008.05.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/19/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022]
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Lichtenfels E, Frankini AD, Bonamigo TP, Cardozo MA, Schulte AA. Popliteal Artery Aneurysm Surgery: The Role of Emergency Setting. Vasc Endovascular Surg 2008; 42:159-64. [DOI: 10.1177/1538574407308201] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the outcomes of emergent surgery caused by acute complications versus elective surgery of popliteal artery aneurysms (PAAs) and to evaluate the advantages of elective repair related to limb salvage and bypass patency rates. Fifty PAAs were operated on in 40 patients from January 2000 to December 2004. Surgery was elective in 34 cases (68%) and emergent in 16 (32%). Emergent repair was performed because of acute complications. All patients were treated surgically. Early results in terms of limb salvage, primary patency, and assisted patency were assessed. Follow-up consisted of clinical and/or ultrasonographic examinations at 10 days and 1, 3, 6, and 12 months and yearly thereafter. Long-term limb salvage and bypass patency rates were analyzed. The mean follow-up was 17 months. The 1-year limb salvage rate in the elective group was 97.1% versus 56.3% in the emergent group ( P = .0007). The bypass patency rate at 1 year was 94.1% in the elective group versus 66.7% in the emergent group ( P = .03). In this study, the outcomes of the PAA repair were significantly better in the group operated electively and without acute symptoms at presentation compared with the group with acute complications, operated on emergently, especially related to limb salvage and bypass patency rates.
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Affiliation(s)
- Eduardo Lichtenfels
- Department of Vascular Surgery, Federal Faculty of Medical Sciences of Porto Alegre, Santa Casa Hospital Porto Alegre, Brazil,
| | - Airton Delduque Frankini
- Department of Vascular Surgery, Federal Faculty of Medical Sciences of Porto Alegre, Santa Casa Hospital Porto Alegre, Brazil
| | - Telmo Pedro Bonamigo
- Department of Vascular Surgery, Federal Faculty of Medical Sciences of Porto Alegre, Santa Casa Hospital Porto Alegre, Brazil
| | - Marco Aurelio Cardozo
- Department of Vascular Surgery, Federal Faculty of Medical Sciences of Porto Alegre, Santa Casa Hospital Porto Alegre, Brazil
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Vijaya N, Satish K, Ehrlich F, Patetsios P, Raynato B. A Unique Case of Thrombosed Giant Popliteal Aneurysm. Am Surg 2008. [DOI: 10.1177/000313480807400212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a unique case of a giant, thrombosed, and ruptured popliteal aneurysm measuring 13.8 cm x 14.0 cm x 14.0 cm in a 93-year-old man. The patient is a hypertensive smoker with asymptomatic swelling behind the knee for several years who developed pain in the swelling with ecchymosis for 2 weeks before presentation. Despite rupture of the aneurysm, this patient exhibited no ischemic symptoms. The patient underwent emergency surgery in which most of the aneurysmal sac was excised and because of satisfactory collateral circulation, the proximal and distal popliteal artery was suture-ligated. Remarkably, the patient did not require a bypass graft and at follow up is pain-free and ambulating with no clinical signs or symptoms of ischemia. This case is unique in several ways: 1) to our knowledge, this is the largest popliteal aneurysm compared with any case that has been documented in the literature, 2) this is also the oldest reported age ever associated with a popliteal aneurysm, and 3) exclusion suture ligation proximally and distally has resulted in an exceptional outcome.
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Davies RSM, Wall M, Rai S, Simms MH, Vohra RK, Bradbury AW, Adam DJ. Long-term Results of Surgical Repair of Popliteal Artery Aneurysm. Eur J Vasc Endovasc Surg 2007; 34:714-8. [PMID: 17716931 DOI: 10.1016/j.ejvs.2007.06.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 06/26/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the long-term outcome of surgical repair of popliteal artery aneurysms (PAA). METHODS A retrospective review of consecutive patients who underwent surgical PAA repair in two vascular surgery units between 1988 and 2006 was performed. Primary and secondary graft patency, limb salvage and patient survival rates were determined using Kaplan-Meier methods. RESULTS 48 patients underwent repair of 63 PAAs (ligation and bypass=45, interposition grafting=18). The 5-year primary graft patency, secondary graft patency, limb salvage and patient survival rates were 75%, 95%, 98% and 81%, respectively. The 10-year primary graft patency rates were significantly lower for emergency cases (59%) compared with elective cases (66%) (p=0.0023). Thirteen patients (16 PAAs) required a total of 20 late re-interventions. Duplex ultrasound was available in 33 of 45 PAAs treated by ligation and bypass. Five (15%) PAAs demonstrated perfusion of the aneurysm sac at median (range) follow up of 75 (1-246) months after primary repair and two of these required emergency re-operation. CONCLUSIONS These data demonstrate that surgical PAA repair is associated with excellent long-term durability and provide an important benchmark with which to compare results of endovascular PAA repair. Patients treated using the ligation and bypass technique should be enrolled in an aneurysm sac surveillance program.
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Affiliation(s)
- R S M Davies
- University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
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Kropman RHJ, van Santvoort HC, Teijink J, van de Pavoordt HDWM, Belgers HJ, Moll FL, de Vries JPPM. The medial versus the posterior approach in the repair of popliteal artery aneurysms: A multicenter case-matched study. J Vasc Surg 2007; 46:24-30. [PMID: 17606119 DOI: 10.1016/j.jvs.2007.03.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 03/10/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study was conducted to compare the early and mid-term results of the medial and posterior approaches in the surgical treatment of popliteal artery aneurysms (PAAs). METHODS From 1992 to 2006 in three hospitals, 110 popliteal aneurysms needed surgical repair by a posterior or a medial approach. Of 36 aneurysms repaired by the posterior approach, 33 could be case-matched to a medially excluded PAA according to the criteria of (1) patient age, (2) cardiovascular comorbidity, (3) indication for PAA repair, (4) diameter of PAA at time of surgical repair, (5) number of distal outflow vessels at time of surgical repair, and (6) type of bypass or interposition graft (venous or polytetrafluoroethylene). RESULTS During the 30-day postoperative period, seven complications (21%) occurred in each group, no patients died, and no amputations were necessary. Two patients in the posterior group vs none in the medial group (P < .05) needed thrombectomy because of occlusion of the reconstruction. The mean follow-up was 47 months (range, 2 to 176). In this period, 13 deaths occurred, but none were related to the previous interventions. The primary patency rates at 6 months and at 1, 3, and 4 years were 84%, 79%, 66%, and 66% in the posterior group and 96% (P < .05), 93% (P < .05), 76% (P = NS), and 69 % (P = NS) for the medial group, respectively. The secondary patency rates at 6 months, and at 1, 3, and 4 years were 100%, 100%, 100%, and 90% in the posterior group and 96%, 96%, 96%, and 90% in the medial group, respectively (P = NS). Limb salvage rates were 97% for the posterior group and 100% for the medial group (P = NS). No neurologic complications or venous damage was seen in either group. Irrespective of approach, venous reconstructions resulted in significantly higher patency rates compared with prosthetic reconstructions at the 3-year follow-up (84% vs 67%, P < .01). During follow-up, which included duplex scanning, two patients in the medial group needed renewed surgical intervention and posterior exclusion because of persistent flow and growth of the native aneurysm. CONCLUSION Early (<1 year) primary patency rates of the medial approach were significantly better than the posterior approach, possibly because of the limited posterior exposure. However, in the absence of a significant difference in long-term primary and secondary patency rates between the posterior and medial approach, and considering the substantial risk of aneurysm growth after medial approach (up to 22%), the posterior approach might be the surgical method of preference for PAA repair in the long run.
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Affiliation(s)
- Rogier H J Kropman
- Department of Vascular Surgery, St Antonius Hospital Nieuwegein, Koekoekslaan 1, 3430 EM Nieuwegein, The Netherlands
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Ravn H, Bergqvist D, Björck M. Nationwide study of the outcome of popliteal artery aneurysms treated surgically. Br J Surg 2007; 94:970-7. [PMID: 17520712 DOI: 10.1002/bjs.5755] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The aim was to study the epidemiology and outcomes of popliteal artery aneurysm (PA) treated surgically.
Methods
Among 110 000 procedures registered prospectively in the Swedish Vascular Registry (Swedvasc), there were 717 primary operations for PA among 571 patients. Patient records were reviewed and data validated against other registries.
Results
The median age of the patients was 71 years; 5·8 per cent were women. Among 264 legs treated urgently, 235 had acute ischemia and 24 had rupture. Of patients with unilateral PA, 28·1 per cent had an aortic aneurysm, 8·4 per cent an iliac aneurysm and 9·4 per cent a femoral aneurysm. Extra-popliteal aneurysms were more common when the PAs were bilateral (P = 0·004). The rate of limb loss within 1 year of operation was 8·8 per cent; 12·0 per cent for symptomatic and 1·8 per cent for asymptomatic limbs (P < 0·001). Risk factors for amputation were symptomatic disease, poor run-off, urgent treatment, age over 70 years, prosthetic graft and no preoperative thrombolysis when the ischaemia was acute. Amputation rates decreased over time (P = 0·003). Crude survival was 91·4 per cent at 1 year and 70·0 per cent at 5 years.
Conclusion
Multiple aneurysm disease was common when PAs were bilateral. Preoperative thrombolysis of acute thrombosis and the use of vein grafts for bypass improved outcome.
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Affiliation(s)
- H Ravn
- Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Laganà D, Carrafiello G, Mangini M, Caronno R, Giorgianni A, Lumia D, Castelli P, Fugazzola C. Endovascular Treatment of Femoropopliteal Aneurysms: A Five-Year Experience. Cardiovasc Intervent Radiol 2006; 29:819-25. [PMID: 16832594 DOI: 10.1007/s00270-005-0322-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the effectiveness of endovascular treatment of femoropopliteal aneurysms (FPAs). METHODS In the last 5 years, we have treated 17 FPAs (diameter 21-75 cm, mean 38.4 cm; length 27-100 cm, mean 72.5 cm) in 15 patients (age 57-80 years, mean 70.9 years). The diagnosis was obtained by color Doppler ultrasound (CDU) and the procedure was planned by CT angiography (CTA) and preprocedural angiography. Eight FPAs were excluded with only one stent-graft; in 8 patients, two stent-grafts were positioned; and in 1 patient, three stent-grafts were used. In 14 cases we used a Wallgraft endoprosthesis, in 2 cases a Hemobahn, and in 1 case an Excluder contralateral leg. The patients were followed up with CDU and occasionally with CTA. RESULTS Immediate technical success was obtained in 17 of 17 cases (100%). One patient died during the first year. During a mean follow-up of 26.9 months (range 3-60 months) we observed 6 of 16 (38%) stent-graft occlusions (3 of which were recanalized with locoregional thrombolysis and 3 with mechanical thrombectomy). Two stent-grafts were patent at 12 and 24 months. Four patients experienced subsequent occlusions and recanalizations until corrected by surgical bypass (1 at 14 months, 2 at 18 months, and 1 at 36 months). Therefore the primary patency was 63% and assisted patency was 73%. CONCLUSION The endovascular approach is a minimally invasive treatment option for FPAs. Moreover endovascular stent-grafting does not necessarily preclude conventional surgical repair, but it can delay it. Longer follow-up will be needed to determine the long-term patency rate.
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Affiliation(s)
- Domenico Laganà
- Department of Radiology, University of Insubria, Viale Borri, 57-21100 Varese, Italy.
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Barbato HA, Cunha MT, Clauzo AV, Petisco ACG, Rossi FH, Malheiros FD, Oliveira LAV, Izukawa NM. Aneurisma de artéria poplítea com rotura e formação de pseudo-aneurisma. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Paciente relatava história aguda de dor e edema em membro inferior direito há 5 dias, e a semiologia caracterizava pulsos poplíteos amplos e perfusão distal satisfatória. Exames laboratoriais mostraram insuficiência renal, e o exame de ultra-som duplex evidenciou um aneurisma de artéria poplítea à direita roto, com formação de pseudo-aneurisma e um aneurisma de artéria poplítea à esquerda. O paciente foi submetido à exploração cirúrgica por via de acesso posterior, sendo evidenciado pseudo-aneurisma secundário a aneurisma de artéria poplítea roto e realizada endoaneurismorrafia com interposição de veia. A evolução pós-operatória foi boa. A ruptura de um aneurisma de artéria poplítea é uma complicação rara, e apenas um relato de formação espontânea de pseudo-aneurisma foi encontrado na literatura.
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006; 47:1239-312. [PMID: 16545667 DOI: 10.1016/j.jacc.2005.10.009] [Citation(s) in RCA: 735] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113:e463-654. [PMID: 16549646 DOI: 10.1161/circulationaha.106.174526] [Citation(s) in RCA: 2164] [Impact Index Per Article: 120.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wakassa TB, Matsunaga P, da Silva ES, Pinto CA, Kauffman P, Aun R, Puech-Leão P. Follow-up of the aneurysmal sac after exclusion and bypass of popliteal artery aneurysms. Clinics (Sao Paulo) 2006; 61:107-12. [PMID: 16680326 DOI: 10.1590/s1807-59322006000200004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Popliteal artery aneurysms are frequent and may lead to thromboembolic events and limb loss. PURPOSE To evaluate clinical and ultrasonographic follow-up of patients who underwent exclusion of a popliteal artery aneurysm using the technique proposed by Edwards. METHODS Data of all patients who underwent surgery to repair a popliteal artery aneurysm at Hospital das Clinicas, the São Paulo University Medical School between 1996 and 2004 were reviewed. Inclusion criteria were repair with aneurysm exclusion and bypass using the technique proposed by Edwards, as well as the existence of preoperative and postoperative measurements of the aneurysmal sac. RESULTS Data of 16 patients who underwent 20 procedures for popliteal artery aneurysm exclusion and bypass were available to analysis. The preoperative diameter of the popliteal artery aneurysms ranged from 1.3 cm to 6.1 cm (mean = 3.1 cm). Patients underwent duplex ultrasound scanning 1 month to 7 years after surgical repair. Follow-up of the 20 cases revealed that 10 aneurysms exhibited decreased mean transverse diameters, ranging from 0.2 to 2.3 cm, while 7 had increased in diameter, ranging 0.3 to 3.3 cm, and 3 remained unchanged. Flow was observed only in 5 out of the 20 procedures, 3 of which (60%) had increased diameters. CONCLUSION Although exclusion is a widely accepted procedure for the repair of popliteal artery aneurysms, data in the literature and the results of this study, which did not include cases of rupture or compression, suggest that strict follow-up of patients who undergo aneurysm exclusion is necessary.
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Affiliation(s)
- Tais Bugs Wakassa
- Department of Vascular Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, SP, Brazil.
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ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary. Circulation 2006. [DOI: 10.1161/circulationaha.106.173994] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pulli R, Dorigo W, Troisi N, Innocenti AA, Pratesi G, Azas L, Pratesi C. Surgical management of popliteal artery aneurysms: Which factors affect outcomes? J Vasc Surg 2006; 43:481-7. [PMID: 16520159 DOI: 10.1016/j.jvs.2005.11.048] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 11/30/2005] [Indexed: 11/20/2022]
Abstract
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. Follow-up was available in 116 patients (84.7%) and 138 limbs (86%) with a mean follow-up time of 40 months (range, 1-205 months). 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.
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Affiliation(s)
- Raffaele Pulli
- Department of Vascular Surgery, University of Florence, Florence, Italy.
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Deglise S, Qanadli SD, Rizzo E, Ducrey N, Doenz F, Haller C, Denys A, Corpataux JM. Long-term follow-up of surgically excluded popliteal artery aneurysms with multi-slice CT angiography and Doppler ultrasound. Eur Radiol 2006; 16:1323-30. [PMID: 16416278 DOI: 10.1007/s00330-005-0034-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 09/01/2005] [Accepted: 09/13/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate the role of multi-slice computed tomography (MSCT) angiography in the follow-up of popliteal artery aneurysms (PAAs) that have been operated on. Aneurysm exclusion and progression, graft patency and graft-related complications were analyzed. Fourteen patients with 21 surgically excluded PAAs were evaluated with MSCT angiography with slice thickness of 1.25 mm. The mean follow-up time was 67 months. MSCT demonstrated blood flow in six non-excluded PAAs (24%), with an average increase in the diameter of 21 mm over time. Fifteen PAAs demonstrated no blood flow and revealed an average decrease of 7 mm in diameter. The origin of this residual perfusion was demonstrated, and collaterals were involved in five of six non-excluded PAAs. In addition, MSCT demonstrated three graft stenoses. Furthermore, two occluded grafts were visualized. Twenty-four percent of the patients after surgical exclusion of PAAs revealed residual perfusion within the aneurysmal sac during follow-up, with a significant increase in the aneurysmal size with MSCT. Moreover, evaluation of the graft patency could also be done as could demonstration of anastomotic abnormalities. Thus, MSCT might be considered as a new tool to evaluate residual collateral feeding of popliteal aneurysmal sac and could be useful in identification and localization of feeding vessels.
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Affiliation(s)
- Sebastien Deglise
- Department of Thoracic and Vascular Surgery, CHUV, Lausanne, Switzerland
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Antonello M, Frigatti P, Battocchio P, Lepidi S, Cognolato D, Dall'Antonia A, Stramanà R, Deriu GP, Grego F. Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: Results of a prospective randomized study. J Vasc Surg 2005; 42:185-93. [PMID: 16102611 DOI: 10.1016/j.jvs.2005.04.049] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 04/23/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this prospective randomized study was to evaluate the relative risks and advantages of using the Hemobahn graft for popliteal artery aneurysm (PAA) treatment compared with open repair (OR). The primary end point was patency rate; secondary end points were hospital stay and length of surgical procedure. METHODS The study was a prospective, randomized clinical trial carried out at a single center from January 1999 to December 2003. Inclusion criteria were an aneurysmal lesion in the popliteal artery with a diameter > or = 2 cm at the angio-computed tomography (CT) scan, and proximal and distal neck of the aneurysm with a length of > 1 cm to offer a secure site of fixation of the stent graft. Exclusion criteria were age < 50 years old, poor distal runoff, contraindication to antiplatelet, anticoagulant, or thrombolytic therapy, and symptoms of nerve and vein compression. The enrolled patients were thereafter prospectively randomized in a 1-to-1 ratio between OR (group A) or endovascular therapy (ET) (group B). The follow-up protocol consisted of duplex ultrasound scan and ankle-brachial index (ABI) measured during a force leg flexion at 1, 3, and 6 months. Group B patients underwent an angio-CT scan and plain radiography of the knee with leg flexion (> 120 degrees) at 6 and 12 months, and then yearly. RESULTS Between January 1999 and December 2003, 30 PAAs were performed: 15 OR (group A) and 15 ET (group B). Bypass and exclusion of the PAA was the preferred method of OR; no perioperative graft failure was observed. Twenty stent grafts were placed in 15 PAAs. Endograft thrombosis occurred in one patient (6.7%) in the postoperative period. The mean follow-up period was 46.1 months (range, 12 to 72 months) for group A and 45.9 months (range, 12 to 65 months) for group B. Kaplan-Meier analysis showed a primary patency rate of 100% at 12 months for OR and 86.7% at 12 months with a secondary patency rate of 100% at 12 and 36 months for ET. No statistical differences were observed at the log-rank test. The mean operation time (OR, 155.3 minutes; ET, 75.4 minutes) and hospital stay (OR, 7.7 days; ET, 4.3 days) were statistically longer for OR compared with ET (P < .01). CONCLUSION We can conclude, with the power limitation of the study, that PAA treatment can be safely performed by using either OR or ET. ET has several advantages, such as quicker recovery and shorter hospital stay.
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Abstract
OBJECTIVE To discuss the management of a patient with unilateral lower extremity pain as a consequence of a popliteal aneurysm. CLINICAL FEATURES An 85-year-old male had difficulty in ambulating due to low back and lower extremity pain. Standard tests demonstrated and reproduced pain at the lower back while inspection, palpation, and auscultation revealed a pulsatile mass in the popliteal fossa of the right knee. INTERVENTION AND OUTCOME Specific joint manipulation for relief of low back pain was performed. Comanagement of the patient with a vascular surgeon and subsequent surgical intervention resulted in relief of lower extremity pain. CONCLUSION Resolution of pain and guarded gait was accomplished by a multidisciplinary approach combining conservative care and invasive techniques.
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Affiliation(s)
- Rod L Kaufman
- University Health Center, Glendale, Calif 91205, USA.
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Blanco E, Serrano-Hernando FJ, Moñux G, Vega M, Martin A, Rial R, Reina T, Sánchez-Hervas L. Operative Repair of Popliteal Aneurysms: Effect of Factors Related to the Bypass Procedure on Outcome. Ann Vasc Surg 2004; 18:86-92. [PMID: 14564550 DOI: 10.1007/s10016-003-0062-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to compare patency rates following the repair of popliteal aneurysms according to the site of inflow, material of bypass graft and quality of distal runoff. Seventy bypasses were performed over an 11-year period. Autogenous saphenous vein was used in 53 procedures (75.7%) and prosthetic material was used in 17 (24.3%). Early mortality was 2.8%. Early primary and secondary patency rates were 95.7% and 97.1%, respectively. Autogenous vein showed better 10-year patency than prosthetic material (86% vs. 57%; p = 0.02). No significant differences in patency were observed according to the inflow site (87.8% groin vs. 74.7% supragenicular). Bypasses that originated in the groin showed improved patency when a saphenous vein was used (84.8% vs. 43.7%; p = 0.01). However, no influence of the graft material was noted in supragenicular bypasses (90.4% vs. 84.8%; p = 0.6). Bypasses in extremities with good runoff showed better patency than those in limbs showing poor runoff (86% vs. 55%; p = 0.003). The use of saphenous vein for the repair of popliteal aneurysms showed better results than those with prosthetic material, although in bypasses originating from the distal superficial femoral or above-knee popliteal artery, no significant differences in patency were observed. Good distal runoff was associated with improved overall outcome.
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Affiliation(s)
- E Blanco
- Vascular Surgery Service, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Affiliation(s)
- A Ross Naylor
- Department of Surgery, Leicester Royal Infirmary, England.
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Abstract
BACKGROUND The best management of patients with a popliteal aneurysm has yet to be established. This paper describes an experience of managing both patent and acutely thrombosed popliteal aneurysms. METHODS A prospective study was carried out of all patients who presented with a popliteal aneurysm from January 1988 to December 2001. Since 1993 asymptomatic popliteal aneurysms less than 3 cm in diameter without distortion have been managed conservatively. Ultrasonography was repeated at 6-month intervals. These results were compared with conservative management of popliteal aneurysms greater than 3 cm in diameter in patients who declined or were unfit for operation, and with the outcome of patients who underwent elective bypass of a popliteal aneurysm. RESULTS Fifty-eight patients (two women) presented with 92 popliteal aneurysms. Some 39 had a thrombosed aneurysm and these patients were significantly more likely to have bilateral aneurysms (P < 0.001). Of patent popliteal aneurysms managed conservatively, none below 3 cm in diameter thrombosed. The risk of postoperative complications was greater after repair of a thrombosed than a patent aneurysm (P < 0.005). Preoperative lysis for a thrombosed popliteal aneurysm was associated with more complications than operation and on-table lysis (P < 0.05). CONCLUSION Careful monitoring of asymptomatic popliteal aneurysms less than 3 cm in diameter is safe. Preoperative lysis is associated with increased risks compared with operation alone in patients with a thrombosed popliteal aneurysm.
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Affiliation(s)
- R B Galland
- Department of Surgery, Royal Berkshire Hospital, Reading RG1 5AN, UK.
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Tratamiento quirúrgico del aneurisma poplíteo. ANGIOLOGIA 2002. [DOI: 10.1016/s0003-3170(02)74721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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