A multicenter study of popliteal aneurysms

Varga, Zsolt; Locke-Edmunds, Jill C.; Baird, R. N.

doi:10.1016/0741-5214(94)90003-5

Cited by 137 publications

(115 citation statements)

References 15 publications

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“…However, size does relate to symptoms. 20 We found 10 that the median diameter of asymptomatic popliteal aneurysms was 2.0 cm (range, 1.5-4.8 cm). This compared with 3 cm (range, 1.4-4.6 cm) for popliteal aneurysms producing acute ischaemia and 3.45 cm (range, 3.0-5.6 cm) for those producing compression ( P = 0.0021 and P = 0.0045, respectively).…”

Section: Sizementioning

confidence: 98%

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Popliteal Aneurysms: From John Hunter to the 21st Century

Galland

2007

annals

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Popliteal aneurysms are rare and tend to occur in older men with significant co-morbidity. Historically, management of popliteal aneurysms can be considered in three broad groups: (i) the technique of Antyllus; (ii) techniques relying upon a collateral circulation; and (iii) techniques involving maintenance or restoration of circulation. Bypass and exclusion is currently been challenged by endovascular techniques which show promise in selected cases.Current controversies in popliteal aneurysms management are: when to repair asymptomatic aneurysms, what operation to do and how to manage acute thrombosis. These have been addressed by studying, prospectively, 73 patients presenting with 116 popliteal aneurysms. Diameter greater than 2c m is often stated as being an indication for elective operation in asymptomatic popliteal aneurysms. However, distortion of the aneurysm appears to be at least as important as size in determining whether symptoms are likely to develop. Of 17 popliteal aneurysms followed for a median of 34 months with a diameter 2-3 cm and distortion less than 45°, none thrombosed. This is no worse than patency following elective bypass ( P = 0.064). Popliteal aneurysms greater than 3c m in diameter in patients who are unfit or who declined an operation were significantly more likely to develop thrombosis or any other symptom ( P = 0.01 and P = 0.004, respectively). Popliteal aneurysms less than 3c m in diameter with distortion less than 45°can safely be managed by ultrasound surveillance. Popliteal aneurysms with greater diameter or distortion are best operated upon.Bypass, combined with proximal and distal ligation of the aneurysm, resulted in 5-year graft patency of 78% and 65% for popliteal aneurysms originally patent or thrombosed, respectively, with good long-term exclusion of the aneurysm.In addition to the general complications of intra-arterial thrombolysis, acute deterioration of the limb during lysis appears to be a particular problem when dealing with thrombosed popliteal aneurysms. It occurs in about 13% of cases which compares with 2% when dealing with thrombosed grafts or native arteries. Intra-arterial thrombolysis for thrombosed popliteal aneurysms is associated with unacceptably high numbers of complications and thrombolysis should be reserved for intra-operative use only.

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Section: Sizementioning

confidence: 98%

“…20 One study has shown a greater risk of complications developing in those popliteal aneurysms associated with absent distal pulses. 21 It is postulated that embolisation from the aneurysm can gradually occlude runoff.…”

Section: Thrombus Within Popliteal Aneurysm and Run-offmentioning

confidence: 99%

Popliteal Aneurysms: From John Hunter to the 21st Century

Galland

2007

annals

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“…Thrombolysis has been shown to improve outcome in the emergency treatment of patients with acute thrombosis 13 by improving run off.…”

Section: Discussionmentioning

confidence: 99%

Screening and management of asymptomatic popliteal aneurysms

Trickett

Scott²,

Tilney³

2002

J Med Screen

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Objectives: To determine the prevalence of popliteal aneurysms in men to enable the case for screening and elective surgery to be assessed. Setting: Scott Research Unit, St Richards Hospital, Chichester. Methods: The popliteal arteries of 1074 men aged between 65 and 80 were scanned with ultrasound, aneurysmal vessels >1.5 cm diameter were rescanned 5 years later to assess their rate of expansion. Results: 11 of 1074 patients screened had a popliteal aneurysm between 15 and 26 mm, a prevalence of 1.0%. Five years later no increase in aneurysm size had occurred and no related complications were reported. Conclusion: In men the low prevalence and complication rate of popliteal aneurysms in conjunction with the effective treatment of acutely thrombosed aneurysms provides evidence for conservative management but against screening asymptomatic popliteal aneurysms. P opliteal aneurysms constitute 70% of peripheral aneurysms.1 Atherosclerosis is the most common association but other proposed aetiologies include, popliteal artery entrapment, collagen disorders, infection, and trauma. Popliteal aneurysms are most common in men in their 60s and are often bilateral (38%-58%).2 There is a high association with abdominal aortic aneurysm, coexisting in 69% of people with bilateral popliteal aneurysms.3 Most popliteal aneurysms are asymptomatic, with complication rates reported between 8% and 29%, for follow up over 3 and 8 years respectively. Symptomatic aneurysms account for only one in 5000 general surgical admissions; one popliteal aneurysm is seen for every 15 abdominal aortic aneurysms. 6 The commonest and most significant complication is acute leg ischaemia secondary to distal embolisation blocking the calf arteries and subsequent thrombosis of the aneurysm. Rupture is rare, constituting only 3% of complications. Results from elective surgery are variable but Duffy et al 8 concluded that elective repair of popliteal aneurysms is a safe, effective, and durable technique. They reported a lower complication rate from repair of asymptomatic as opposed to symptomatic patients. To minimise the complication rate it is logical to detect and then operate on asymptomatic patients. Clinical history and examination is known to be unreliable at diagnosing popliteal aneurysms. 9 We therefore utilised ultrasound scanning for detection. We set out to assess the prevalence in the general population, which is fundamental to screening.Present data on prevalence is restricted to population groups with abdominal aortic aneurysms. Diwan et al 10 reported a significantly higher prevalence of popliteal aneurysms in men compared with women (p<0.01), 14% of men had popliteal aneurysms in a population known to have abdominal aortic aneurysms and a mean (SD) age of 74 (7) (Diwan et al defined popliteal aneurysm at a smaller size than this series, which would elevate the prevalence). The prevalence of abdominal aortic aneurysms in men over 65 has been reported as 7.6%.11 Taking account of the fact that Duffy et al reported that about 50% of men (me...

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“…6 The most common surgical technique used for the repair of a PAA is the medial approach with proximal and distal aneurysms ligation, combined with autologous vein or polytetrafluoroethylene (PTFE) bypass grafting. 7 However, this technique does not exclude side branches with their origin in the PAA, which may be responsible for continued retrograde perfusion in the ligated aneurysm, which can eventually lead to aneurysm enlargement. 5,8 An alternative technique is the posterior approach.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms

Igari

Kudo

Toyofuku

et al. 2016

International Surgery

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Abstract:Purpose: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. Methods: Between January 1980 and December 2013, forty-five 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 with using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative-mortality, postoperative-morbidity, graft patency, and limb salvage. Results: During the study period, forty-five limbs [35 patients, mean age: 60 years] were subjected to open surgical repair. 25 limbs were treated through a posterior approach with using 23 autologous vein grafts (AVGs), and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach with using 13 AVGs, and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at one, three and five years were 88.0%, 75.7% and 75.7%, respectively, and the limb salvage rates at one, three and five 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). Conclusion: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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A multicenter study of popliteal aneurysms

Abstract: Intraarterial thrombolysis is of value in restoring the distal run off before bypass in PA presenting as acute limb-threatening ischemia. However, the results do not justify an expectant policy for asymptomatic aneurysms.

Cited by 137 publications

References 15 publications

Popliteal Aneurysms: From John Hunter to the 21st Century

Popliteal Aneurysms: From John Hunter to the 21st Century

Screening and management of asymptomatic popliteal aneurysms

Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms

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