Preoperative Intraarterial Thrombolysis before Surgical Revascularization for Popliteal Artery Aneurysm with Acute Ischemia

Steinmetz, Éric; Bouchot, Olivier; Faroy, Francis; Charmasson, L.; Terriat, Béatrice; Becker, F.; Cercueil, Jean-Pierre; Krausé, D.; Brenot, R; David, Michel

doi:10.1007/s100169910062

Cited by 26 publications

(17 citation statements)

References 35 publications

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“…The efficacy of the surgical repair of PAA has been widely demonstrated in several reports (12, 13). Surgical intervention provides excellent results both in asymptomatic and in chronic symptomatic aneurysms, while also in acutely complicated lesions the possibility of preoperative thrombolysis allows in many cases to perform a successful elective intervention after the restoration of the patency of popliteal artery and tibial vessels, without compromising the results of surgery if unsuccessful (14, 15).…”

Section: Discussionmentioning

confidence: 99%

A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms

et al. 2018

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Section: Discussionmentioning

confidence: 99%

A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms

et al. 2018

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“…28,29 PAAs often generate emboli that progressively occlude the distal arterial network, making thrombolysis a valuable first line approach, which later in elective settings can be followed by surgical repair of the aneurysm. 29,30 The poor patency rate after thrombolysis for occluded PAA, might be explained by incomplete runoff clearance of fresh and/or old embolic clots. This subgroup, however, had the best amputation free survival at 5 years and higher survival after 5 years.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Grip

Wanhainen

Acosta

et al. 2017

European Journal of Vascular and Endovascular Surgery

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WHAT THIS STUDY ADDS Reporting on the long-term outcome in a large cohort of patients treated with intra-arterial thrombolysis for acute lower limb ischaemia makes it possible to analyse the four main aetiological subgroups. Patients treated for occluded grafts, stents, or stent grafts had a higher risk of amputation and a lower amputation free survival, indicating the need for better treatment and follow-up. Re-interventions were most common after occluded grafts/stents/stent grafts, followed by occluded popliteal aneurysms, and native artery thrombosis, and least common after embolus. Overall, thrombolytic therapy achieved good medium and long-term clinical outcome and transformed an emergent into an elective situation. Objectives: The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%. Results: The mean follow-up was 59.4 months (95% CI, 56.1e62.7), during which 32.9% needed further re-interventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p ¼ .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p ¼ .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p ¼ 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p ¼ .007). Conclusion: Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Grip¹,

Wanhainen²,

Acosta³

et al. 2017

Journal of Vascular Surgery

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WHAT THIS STUDY ADDSReporting on the long-term outcome in a large cohort of patients treated with intra-arterial thrombolysis for acute lower limb ischaemia makes it possible to analyse the four main aetiological subgroups. Patients treated for occluded grafts, stents, or stent grafts had a higher risk of amputation and a lower amputation free survival, indicating the need for better treatment and follow-up. Re-interventions were most common after occluded grafts/stents/stent grafts, followed by occluded popliteal aneurysms, and native artery thrombosis, and least common after embolus. Overall, thrombolytic therapy achieved good medium and long-term clinical outcome and transformed an emergent into an elective situation. Objectives:The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%. Results: The mean follow-up was 59.4 months (95% CI, 56.1e62.7), during which 32.9% needed further reinterventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p ¼ .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p ¼ .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p ¼ 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p ¼ .007). Conclusion: Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.

show abstract

Preoperative Intraarterial Thrombolysis before Surgical Revascularization for Popliteal Artery Aneurysm with Acute Ischemia

Cited by 26 publications

References 35 publications

A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms

A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

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