A 33-year experience with surgical management of popliteal artery aneurysms

Dorigo, Walter; Pulli, Raffaele; Innocenti, Alessandro; Azas, Leonidas; Fargion, Aaron; Chiti, E; Matticari, Stefano; Pratesi, Carlo

doi:10.1016/j.jvs.2015.06.216

Cited by 33 publications

(13 citation statements)

References 24 publications

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“…In an elective setting, PAA can be treated with low morbidity and mortality and excellent long-term outcomes that are far superior to the results in acute ischaemia. 11,19 Therefore, the aim is to search for PAA in patients with known aneurysms at other sites and operate on them electively at a diameter of 20 mm.…”

Section: Discussionmentioning

confidence: 99%

Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm

Jungi

Kuemmerli

Kissling

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This study reports a single centre series of open surgical management of acute presentation of thrombosed popliteal artery aneurysm. It stands out from other contemporary reports owing to the inclusion of patients with severe ischaemia and complete follow up (median 41 months, follow up index 0.99). Rapid open surgical revascularisation without pre-operative thrombolysis can lead to good rates of limb salvage and bypass patency despite poor runoff. Objective: Acute ischaemia due to thrombosed popliteal artery aneurysm (PAA) is associated with a high risk of limb loss. The aim of this study was to analyse the outcome, in particular the limb salvage rate in patients undergoing urgent open surgery for acute ischaemia due to thrombosed PAA. Methods: This was a retrospective analysis of consecutive patients undergoing urgent open surgery for acute limb ischaemia (Rutherford category ! II) due to thrombosed popliteal artery aneurysm between January 2007 and December 2016 at a tertiary referral centre. Results: Fifty-one patients (92% male), median age 75 years (range 46e97 years), were identified. Twenty patients (39%) presented with category IIa acute limb ischaemia, 20 (39%) with category IIb, and 11 (22%) with category III. Four patients (8%) underwent primary major amputation. Forty-seven (92%) underwent bypass surgery, 43/47 (91%) using great saphenous vein. One vessel runoff was present in 27/47 patients (57%). Thirty day mortality was 4% (n ¼ 2). Four patients needed major amputation within 30 days, resulting in an overall 30 day major amputation rate of 16% (8/51, 95% confidence interval 7.0e28.6). No further major amputations were necessary during a median follow up of 41 months (range 4e114 months) resulting in an estimated 4 year limb salvage of 84%. The one year primary assisted and secondary bypass patency rates were 90% and 95%, respectively. The estimated four year primary assisted and secondary patency rates were 82% and 87%, respectively. Conclusion: Rapid open surgical revascularisation in patients with acute limb ischaemia due to a thrombosed popliteal artery aneurysm results in good long-term limb salvage rates, especially Rutherford category IIa and IIb acute ischaemia. Revascularisation may be attempted in clinically severe cases not fulfilling all criteria to be classified as category III. Such patients may, in fact, be borderline between IIb and III. Despite poor runoff, good bypass patency rates and low rates of claudication can be achieved.

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Section: Discussionmentioning

confidence: 99%

Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm

Jungi

Kuemmerli

Kissling

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…Recientemente, en la Universidad de Uppsala, Cervit et al (15) evaluaron 592 pacientes concluyendo que la reparación endovascular (Imagen N° 6), exhibió resultados claramente inferiores a los procedimientos abiertos sobre todo en aquellos pacientes que presentaban isquemia arterial aguda. Similares resultados publicaron Dorigo et al (16) , afirmando que a largo plazo la cirugía abierta tiene mejores resultados que los procedimientos endovasculares.…”

Section: Discussionunclassified

“…El índice de amputaciones para distintos autores fue variable, ubicándose entre un 7% y un 33% con una media cercana al 15% (8)(9)(10)(11)(12)(13)(14)(15)(16) .…”

Section: Discussionunclassified

Aneurismas de la Arteria Poplitea: Revisión bibliográfica y presentación de un caso

Cecenarro

Allende

Molinelli

et al. 2018

Rev Fac Cien Med Univ Nac Cordoba

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. Resumen:Introducción: El aneurisma de la arteria poplítea (AAP) es la dilatación localizada e irreversible de las paredes de la Arteria Poplítea. Es patología poco frecuente, constituye la segunda ubicación más frecuente de aneurismas verdaderos luego de los aórticos, y la primera ubicación dentro de los aneurismas periféricos. Se caracteriza por afectar a principalmente a hombres a una edad promedio de 65 años, cuyas manifestaciones son principalmente de origen isquémico, acabando en amputación del miembro inferior en una frecuencia que oscila según los casos entre un 7 y un 20 por ciento. Nuestro objetivo es realizar la presentación de un caso de AAP con isquemia arterial subaguda, junto con una actualización bibliográfica del tema. Presentación de caso: Se presenta el caso de un paciente de 63 años de edad quien consultó por dolor de miembro inferior 96 horas de evolución, con ausencia de pulsos. Se realizó el diagnóstico de isquemia subaguda evolucionada, no resvascularizable en el contexto de un paciente clínicamente inestable. Se decide amputación de urgencia. En la disección se objetiva la presencia de un AAP. Discusión: Los AAP tienen una incidencia de entre el 0,1 al 1%, presentan clínica variable. La arteriografía es gold standard para su diagnóstico. El tratamiento de elección es quirúrgico, presentándose nuevas opciones terapéuticas. Las variaciones anatómicas de las ramas de la AP son una variable a considerar. Los aneurismas asociados con mayor frecuencia son los poplíteos contralaterales (57,1%). Conclusiones: Concluimos que nuestra conducta fue adecuada considerando el estado del paciente.Palabras clave: aneurisma de la arteria poplítea; reporte de caso; revisión bibliográfica. Abstract:Introduction: The popliteal artery aneurysm (AAP) is localized and irreversible walls of the popliteal artery dilation. It is rare pathology is the second most common location of true aneurysms after aortic, and the first location within the peripheral aneurysms. It is characterized by affecting mainly men at an average age of 65, whose manifestations are mainly ischemic, finishing lower limb amputation in a frequency ranging as appropriate between 7 and 20 percent. Our goal is to make the presentation of a case of AAP with subacute arterial ischemia, along with a literature review of the topic. Case presentation: the case of a 63 year old who consulted for lower limb pain 96 hours of evolution, with absence of pulses is presented a diagnosis of advanced subacute ischemia was performed resvascularizable not in the context of a clinically unstable patient. emergency amputation is decided. In dissecting the presence of PSA objective. Discussion: The AAP have an incidence of 0.1 to 1%, have variable clinical. Arteriography is the gold standard for diagnosis. The treatment of choice is surgical, presenting new therapeutic options. The anatomical variations of the branches of the PA are variable to consider. Aneurysms are most commonly associated with contralateral popliteal (57.1%). Conclusions: We conclude that our...

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Section: Imagenunclassified

Aneurismas de la Arteria Poplitea: Revisión bibliográfica y presentación de un caso

Cecenarro

Allende

Molinelli

et al. 2018

Rev Fac Cien Med Univ Nac Cordoba

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A 33-year experience with surgical management of popliteal artery aneurysms

Abstract: Open surgical repair of PAAs provided good results in our experience, with low rates of perioperative complications and an excellent durability in the very long-term setting, representing the benchmark for alternative techniques such as endovascular repair.

Cited by 33 publications

References 24 publications

Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm

Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm

Aneurismas de la Arteria Poplitea: Revisión bibliográfica y presentación de un caso

Aneurismas de la Arteria Poplitea: Revisión bibliográfica y presentación de un caso

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