Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden

Cervin, Anne; Tjärnström, Johan; Ravn, Hans; Acosta, Stefan; Hultgren, Rebecka; Welander, Martin; Björck, Martin

doi:10.1016/j.ejvs.2015.03.026

Cited by 89 publications

(50 citation statements)

References 33 publications

(30 reference statements)

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“…Mazzacaro et al (12) , no hallaron diferencias significativas entre ambas vías de abordaje, observandosé buenos resultados para ambas. Hoelting et al (15) describieron el valor de la terapia lítica con urokinasa preoperatoria. En su estudio el índice de amputaciones fue del 9% para los pacientes tratados previamente con urokinasa, y del 25% para aquellos que solo fueron tratados con cirugía.…”

Section: Discussionunclassified

“…La media de seguimiento fue de 34 meses, registraron 3 oclusiones, dos de ellas se recanalizaron mediante tratamiento fibrinolítico y la permeabilidad primaria durante el seguimiento fue del 75% y 92% la secundaria. 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

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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: 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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“…Between 20% and 40% of PAA cases are discovered unexpectedly because of ALI. 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.…”

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.

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“…Popliteal artery aneurysm (PAA) is a relatively rare disease in the population, 1 although it is the most frequently found arterial aneurysm after abdominal aortic aneurysm (AAA). 2,3 The prevalence of AAA in the general population is approximately 1.5-2.5%.…”

Section: Introductionmentioning

confidence: 99%

Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms

2016

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Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort (n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (⩾ 10.5, ⩾ 12, ⩾ 15 mm), although the overall analysis is based on PAA ⩾ 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% (n=43) by definition ⩾ 12 mm, and 11% (n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries.

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Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden

Abstract: Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden Cervin, A.; Tjarnstrom, J.; Ravn, H.; Acosta, Stefan; Hultgren, R.; Welander, M.; Bjorck, M.

Cited by 89 publications

References 33 publications

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

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

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms

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