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Surgical technique and long-term results after popliteal artery aneurysm repair: Results from 717 legs
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: Journal of Vascular Surgery, ISSN 0741-5214, Vol. 46, no 2, 236-243 p.Article in journal (Refereed) Published
Abstract [en]

Background

This study investigated the importance of surgical technique on long-term outcome after treatment of popliteal artery aneurysms (PAAs).

Methods

Records from 571 patients (717 legs) primarily operated on for PAAs were identified in the Swedish Vascular Registry. Surgical approach, type of graft, and anastomotic and ligation techniques were studied. After mean 7.2 years (range, 2 to 18 years) information on amputation was obtained for all patients, and 190 patients were re-examined with ultrasound imaging.

Results

The approaches used were medial (medial approach group, MAG) in 87%, posterior (PAG) in 8.4%, endovascular in 3.6%, and other in 1.4%. Primary patency at 1 year with venous and prosthetic grafts was 85% vs 81% in the PAG (P = .719) and 90% vs 72% in the MAG (P < .001). Sixty-three legs (8.8%) were amputated ≤1 year, and 80 (11%) had been amputated at re-examination or by the end of follow-up. The median time from operation to amputation of 17 legs amputated after 1 year was 3.1 years (range, 1.1 to 9.8 years). The frequency of late amputation was 3.7% (2/54) in the PAG and 2.6% (15/571) in the MAG. In a Cox regression model, age (odds ratio [OR] 1.06/year, P < .001), emergency procedure (OR 2.67, P < .001), and prosthetic graft (OR 2.02, P = .008) were independently associated with long-term amputation rate. The risk of expansion of the excluded PAA at re-examination was 33% in the MAG and 8.3% in the PAG (P = .014). It was not affected by the ligation technique used.

Conclusions

The risk of late amputation was higher with prosthetic grafts. Operation with a posterior approach decreased the risk of expansion.

Place, publisher, year, edition, pages
2007. Vol. 46, no 2, 236-243 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96056DOI: 10.1016/j.jvs.2007.04.018OAI: oai:DiVA.org:uu-96056DiVA: diva2:170502
Available from: 2007-09-06 Created: 2007-09-06 Last updated: 2010-03-24Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 270
Keyword
Surgery, popliteal artery aneurysm, thrombolytic therapy, acute ischemia, surgical technique, long-term outcome, surveillance, Kirurgi
Identifiers
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
Opponent
Supervisors
Available from: 2007-09-06 Created: 2007-09-06Bibliographically approved

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