Late complications after ligation and bypass for popliteal aneurysm

Kirkpatrick, U.J.; McWilliams, Richard G.; Martin, Janis; Brennan, John A.; Gilling-Smith, Geoffrey L.; Harris, Peter L.

doi:10.1002/bjs.4426

Cited by 53 publications

(42 citation statements)

References 7 publications

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“…Symptoms have been described in 8-17%. 13,15,28,29 However, we found that, following proximal and distal ligation and bypass, no popliteal aneurysm developed either symptoms or ultrasound-detected flow.…”

Section: Fate Of the Excluded Aneurysmmentioning

confidence: 63%

“…[12][13][14][15][16][17][18] This is usually due to thrombosis but thrombus from the aneurysm can embolise distally. About a quarter of popliteal aneurysms are associated with intermittent claudication, either from thrombosis, repeated micro-emboli or combined stenotic arterial disease.…”

mentioning

confidence: 99%

“…Despite this, approximately 25-50% of popliteal aneurysms which undergo operation are asymptomatic. [12][13][14][15][16][17][18] Using a Markov decision analysis, we calculated that the average rate of developing symptoms was 14% per year and it was 16 months before a break-even point was reached such that the patient benefited from the operation.…”

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confidence: 99%

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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: Fate Of the Excluded Aneurysmmentioning

confidence: 63%

mentioning

confidence: 99%

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Popliteal Aneurysms: From John Hunter to the 21st Century

Galland

2007

annals

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“…U svojoj studiji Tielliu i sur. navode da je u 57 sluča-jeva poplitealnih aneurizmi podvrgnutih endovaskularnom liječenju dvogodišnja prohodnost iznosila 77 %, što se podudara s drugim recentnim studijama 1, 21 . U svome istraživanju Lovegrove i sur.…”

Section: Dominacija Medijalnog Pristupaunclassified

“…U ovoj metodi ne postoji mogućnost korištenja prirodnih transplantata, već isključivo umjetnih materijala, kako bi se uspostavio normalan krvotok što je lošija varijanta, jer oni brže podliježu trombozi i začepljenju. Također, kod nekih pacijenata dolazi do prodora krvi u aneurizmu s distalne strane te njezinog daljnjeg rasta, embolizacije tromba i pojave distalne ishemije uda 1, 21 . U nekih slučajeva zamijećena je i migracija stenta, odnosno njegovo pomicanje te gubitak funkcije, iako je prvotno bio ispravno stavljen i pozicioniran.…”

Section: Zaključakunclassified

Outcome of surgical and endovascular treatment of popliteal artery aneurysms

Roth¹,

Oljača²,

Kovačević

2017

Med. flum.

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Sažetak. Aneurizma poplitealne arterije lokalizirano je proširenje lumena poplitealne arterije koje najčešće nastaje kao posljedica ateroskleroze. Epidemiološka istraživanja pokazuju da su ovo najčešće aneurizme perifernih arterija s incidencijom od 0,1 do 2,8/100.000 ljudi koje uglavnom zahvaćaju mušku populaciju. U približno 50 % pacijenata aneurizme se nalaze bilateralno, a u 78 % slučajeva pacijenti ih imaju i na drugim arterijama, posebno na abdominalnoj aorti i ilijačnim krvnim žilama (64 %). U samom početku bolest je asimptomatska, a kasnije se može prezentirati bolovima, kompresijom, rijetko rupturom. Ako dođe do embolizacije tromba, koji potom distalno uzrokuje akutnu ishemiju ekstremiteta, očituje se plavim nožnim prstima, bljedilom, ulceracijama, gangrenom te u najgorem slučaju završava amputacijom uda. Osnova dijagnostike je višeslojna kompjutorska tomografija (MSCT) angiografija koja predstavlja zlatni standard, a ponekad je dovoljna i palpacija poplitealne jame iza koljenog zgloba. Temelj liječenja je operativni zahvat koji se sastoji od podvezivanja i isključivanja aneurizme iz krvotoka te formiranja i zaobilaženja aneurizme premosnicom. Druga opcija je endovaskularno liječenje, pri čemu se ugrađuje stent unutar aneurizme kako bi se ona isključila iz krvotoka. Prednosti ovog tipa zahvata su brz oporavak i kratko vrijeme hospitalizacije, a pogodna je u pacijenata s visokim operativnim rizikom. Ipak, veliki nedostaci su veća učestalost rane tromboze i začepljenja te veći broj komplikacija u odnosu na operativnu metodu. Operacija medijalnim pristupom najčešća je operativna metoda današnjice u liječenju aneurizmi poplitealnih arterija. Najbitnije prednosti su njeni odlični dugoročni rezultati, odsutnost komplikacija, jednostavnost i kratko trajanje zahvata, zbog čega predstavlja standard i prvu opciju kod liječenja aneurizmi poplitealnih arterija.Ključne riječi: aneurizma; ligatura; poplitealna arterija; stent; tromboza Abstract. Popliteal artery aneurysm is a localized enlargement of lumen of popliteal artery due to atherosclerosis. With incidence of 0.1 -2.8/100,000 people they are the most common aneurysms of peripheral arteries, affecting mostly male population. In about 50 % of patients aneurysms are found bilaterally and in 78 % of cases patients have them on other arteries, mostly (64 %) on abdominal aorta and iliac arteries. At the beginning, disease is asymptomatic and later it can be presented with pain, compression, rarely rupture and, if embolization of the thrombus occurs distal part of the limb will be ischemic, pale, with blue toes, ulcerations, gangrene and in worse case it will end with amputation. Diagnosis is based on multislice computed tomography (MSCT) angiography but sometimes even palpation of popliteal fossa behind knee articulation is enough. Surgical treatment consists of ligation and bypassing the aneurysm to exclude it from the blood flow. Other option is endovascular treatment in which stent is being embedded inside of the aneurism. The advantages of this treatment are qu...

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