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Nationwide study of the outcome of popliteal artery aneurysms treated surgically
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (Vascular Surgery)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (Vascular Surgery)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. (Vascular Surgery)
2007 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 94, no 8, 970-977 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to study the epidemiology and outcomes of popliteal artery aneurysm (PA) treated surgically. Methods: Among 110000 procedures registered prospectively in the Swedish Vascular Registry (Swedvasc), there were 717 primary operations for PA among 571 patients. Patient records were reviewed and data validated against other registries. Results: The median age of the patients was 71 years; 5·8 per cent were women. Among 264 legs treated urgently, 235 had acute ischemia and 24 had rupture. Of patients with unilateral PA, 28·1 per cent had an aortic aneurysm, 8·4 per cent an iliac aneurysm and 9·4 per cent a femoral aneurysm. Extra-popliteal aneurysms were more common when the PAs were bilateral (P = 0·004). The rate of limb loss within 1 year of operation was 8·8 per cent; 12·0 per cent for symptomatic and 1·8 per cent for asymptomatic limbs (P < 0·001). Risk factors for amputation were symptomatic disease, poor run-off, urgent treatment, age over 70 years, prosthetic graft and no preoperative thrombolysis when the ischaemia was acute. Amputation rates decreased over time (P = 0·003). Crude survival was 91·4 per cent at 1 year and 70·0 per cent at 5 years. Conclusion: Multiple aneurysm disease was common when PAs were bilateral. Preoperative thrombolysis of acute thrombosis and the use of vein grafts for bypass improved outcome.

Place, publisher, year, edition, pages
2007. Vol. 94, no 8, 970-977 p.
Keyword [en]
Vascular disease, Arterial disease, Cardiovascular disease, Medicine, Surgery, Treatment, Popliteal artery, Prognosis, Evolution, Public health, Artery aneurysm
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-96054DOI: 10.1002/bjs.5755ISI: 000248921700010PubMedID: 17520712OAI: oai:DiVA.org:uu-96054DiVA: diva2:170500
Available from: 2007-09-06 Created: 2007-09-06 Last updated: 2011-01-26Bibliographically approved
In thesis
1. Popliteal Artery Aneurysm: Epidemiology, Surgical Management and Outcome
Open this publication in new window or tab >>Popliteal Artery Aneurysm: Epidemiology, Surgical Management and Outcome
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Even if popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists.

PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)

Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of aneurysms increasing by 42% (from 244 to 346).

Conclusions: Multiple aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed aneurysms timely. Normal arterial segments should be re-examined after three years.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 66 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 270
Surgery, popliteal artery aneurysm, thrombolytic therapy, acute ischemia, surgical technique, long-term outcome, surveillance, Kirurgi
urn:nbn:se:uu:diva-8147 (URN)978-91-554-6933-7 (ISBN)
Public defence
2007-09-28, Auditorium Minus, Museum Gustavianum, Uppsala, 13:00
Available from: 2007-09-06 Created: 2007-09-06Bibliographically approved

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