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Ravn, Hans
Publications (3 of 3) Show all publications
Cervin, A., Ravn, H. & Björck, M. (2018). Ruptured popliteal artery aneurysm. British Journal of Surgery, 105(13), 1753-1758
Open this publication in new window or tab >>Ruptured popliteal artery aneurysm
2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 13, p. 1753-1758Article in journal (Refereed) Published
Abstract [en]

Background: Popliteal artery aneurysms (PAAs) are generally complicated by thrombosis and distal embolization, whereas rupture is rare. The aim of this study was to describe the clinical characteristics and outcome in a cohort of patients who had surgery for ruptured PAA (rPAA).

Methods: Operations for rPAA identified from the Swedish Vascular Registry, Swedvasc, 1987-2012. Medical records and imaging were reviewed. Comparison was made with patients treated for PAA without rupture.

Results: Forty-five patients with rPAA were identified. The proportion with rupture among those operated on for PAA was 2.5 per cent. Patients with rPAA were 8 years older (77.7 versus 69.7years; P < 0.001), had more lung and heart disease (P = 0.003 and P = 0.019 respectively), and a larger mean popliteal aneurysm diameter (63.7 versus 30. 9mm; P < 0.001) than patients with PAA treated for other indications. At time of surgery, 22 of 45 patients were already receiving anticoagulants, seven for concomitant deep venous thrombosis (DVT) in the affected leg. There was extensive swelling of the whole leg in 20 patients. In 27 patients, the initial diagnosis was DVT or a Baker's cyst. All patients underwent surgery, all but three by the open method. There were four amputations, all performed within 1week of surgery. One year after surgery, 26 of the 45 patients were alive. Among these, the reconstructions were patent in 20 of 22 patients.

Conclusion: The diagnosis of rPAA is difficult, and often delayed. The condition affects old patients, who often are on anticoagulation treatment and have large aneurysms. The immediate surgical results are acceptable, but the condition is associated with a high risk of death within the first year after surgery.

Place, publisher, year, edition, pages
WILEY, 2018
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-373014 (URN)10.1002/bjs.10953 (DOI)000450816200010 ()30043540 (PubMedID)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-04-10Bibliographically approved
Ravn, H., Pansell-Fawcett, K. & Björck, M. (2017). Popliteal Artery Aneurysm in Women. European Journal of Vascular and Endovascular Surgery, 54(6), 738-743
Open this publication in new window or tab >>Popliteal Artery Aneurysm in Women
2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 6, p. 738-743Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women.

METHODS:

Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry.

RESULTS:

1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion of small aneurysms (<2 cm) among women than men (24% vs. 8%, p=.005), there was no such difference in asymptomatic aneurysms. Distribution between asymptomatic and symptomatic PA was 31% versus 69%, similar to men. The prevalence of concomitant aneurysms in the aorto-iliac and femoral arteries, and the frequency of presenting symptoms were similar compared with men. Three PA were ruptured (3.7%). Thrombolysis was used in 23 of 45 legs treated for acute ischaemia (51%). Eight legs were treated with endovascular stent grafts (9.8%), compared with 7.9% in men (p=.5). Seven legs were amputated (8.6%). Crude survival was similar to men.

CONCLUSIONS:

PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often <2 cm in diameter. Women had the same survival as men, despite women generally having better life expectancy. Although the largest series ever published on women with PA, the sample size is small, making it prone to type II statistical error.

Keywords
Arterial aneurysm, Popliteal artery, Popliteal artery aneurysm, Sex, Women
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-334977 (URN)10.1016/j.ejvs.2017.10.001 (DOI)000419053800012 ()29126647 (PubMedID)
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2018-02-09Bibliographically approved
Cervin, A., Tjärnstrom, J., Ravn, H., Acosta, S., Hultgren, R., Welander, M. & Björck, M. (2015). Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden. European Journal of Vascular and Endovascular Surgery, 50(3), 342-350
Open this publication in new window or tab >>Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden
Show others...
2015 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 50, no 3, p. 342-350Article in journal (Refereed) Published
Abstract [en]

WHAT THIS STUDY ADDS

Previous comparisons between open and endovascular repair of popliteal aneurysms have focused on asymptomatic patients, and have short follow up. This study is strengthened by the fact that it is contemporary, population based, without any selection bias, reporting on all kinds of presentations, and has approximately 90% 1 year follow up data. It shows that endovascular repair has significantly inferior results compared with open repair, in particular in the group of patients who present with acute ischaemia. We believe these results will make many vascular surgeons think twice before they treat patients endovascularly in the future. Background: Popliteal aneurysm (PA) is traditionally treated by open repair (OR). Endovascular repair (ER) has become more common. The aim was to describe time trends and compare results (OR/ER). Methods: The Swedish vascular registry, Swedvasc, has a specific PA module. Data were collected (2008-2012) and supplemented with a specific protocol (response rate 99.1%). Data were compared with previously published data (1994-2002) from the same database. Results: The number of operations for PA was 15.7/million person-years (8.3 during 1994-2001). Of 592 interventions for PA (499 patients), 174 (29.4%) were treated for acute ischaemia, 13 (2.2%) for rupture, 105 (17.7%) for other symptoms, and 300 (50.7%) were asymptomatic (31.5% were treated for acute ischaemia, 1994-2002, p = .58). There were no differences in background characteristics between OR and ER in the acute ischaennia group. The symptomatic and asymptomatic groups treated with ER were older (p = .006, p < .001). ER increased 3.6 fold (4.7% 1994-2002, 16.7% 2008-2012, p = .0001). Of those treated for acute ischaemia, a stent graft was used in 27 (16.4%). Secondary patency after ER was 70.4% at 30 days and 47.6% at 1 year, versus 93.1% and 86.8% after OR (p = .001, < .001). The amputation rate at 30 days was 14.8% after ER, 3.7% after OR (p = .022), and 17.4% and 6.8% at 1 year (p = .098). A stent graft was used in 18.3% for asymptomatic PA. Secondary patency after ER was 94.5% at 30 days and 83.7% at 1 year, compared with 98.8% and 93.5% after OR (p = .043 and 0.026). OR was performed with vein graft in 87.6% (395/451), with better primary and secondary patency at 1 year than prosthetic grafts (p = .002 and < .001), and with a posterior approach in 20.8% (121/581). Conclusions: The number of operations for PA doubled while the indications remained similar. ER patency was inferior to OR, especially after treatment for acute ischaemia, and the amputation risk tended to be higher, despite similar pre-operative characteristics.

Keywords
Popliteal artery aneurysm, Open repair, Endovascular, Stent graft, Registry, Amputation
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-265621 (URN)10.1016/j.ejvs.2015.03.026 (DOI)000361576800016 ()25911500 (PubMedID)
Funder
Swedish Research Council, K2013-64X-20406-07-3
Available from: 2015-11-04 Created: 2015-11-02 Last updated: 2019-04-10Bibliographically approved
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