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Popliteal Artery Aneurysm with Acute ischemia in 229 Patients: Outcome after Thrombolytic and Surgical Therapy
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: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 33, no 6, 690-695 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to assess the national management and outcome of popliteal artery aneurysm (PAA). Methods: In the Swedish National Registry 717 primary operations for PAA on 571 patients were registered prospectively between 1987 and 2002. 235 patients presented with acute ischemia. Results: Median age was 70 for men and 75 for women. Immediate surgery was performed in 135 legs, including intraoperative thrombolysis in 32 cases (Immediate Surgery Group, ISG). Pre-operative thrombolysis was performed in 100 legs, followed by acute (≤24 hours, 41 legs) or elective (59 legs) surgery (Delayed Surgery Group, DSG). DSG had smaller PAA (27 versus 37 mm, p < 0.0001) and were younger (67 versus 72 years, p < 0.001). Run-off was worse in DSG than in ISG (p < 0.001) and improved in 87% after thrombolysis. Amputation-rate was 27% in the ISG and 7% in the DSG, P < 0.0001. The ISG required fasciotomy in 30% compared to 11% of the DSG, p = 0.0001. Conclusion: Patients in the ISG and DSG differed in their pre-operative characteristics and were selected to the treatment modalities in a complex manner. Preoperative thrombolysis improves run-off.

Place, publisher, year, edition, pages
2007. Vol. 33, no 6, 690-695 p.
Keyword [en]
Popliteal artery aneurysm, Thrombosis, Acute ischemia, Thrombolytic therapy, Surgery
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-96055DOI: 10.1016/j.ejvs.2006.11.040ISI: 000247217500011PubMedID: 17275362OAI: oai:DiVA.org:uu-96055DiVA: diva2:170501
Available from: 2007-09-06 Created: 2007-09-06 Last updated: 2011-04-12Bibliographically 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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