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Risk to develop new aneurysms after surgery for popliteal artery aneurysm
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. 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. 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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 5, 571-575 p.Article in journal (Refereed) Published
Abstract [en]

Background:The risk of developing a new aneurysm after surgery for popliteal artery aneruysm (PAA) is not well known. The aim was to study this risk in a cohort of patients.Methods:A total of 571 patients who had primary operation for PAA (717 legs) between 1987 and 2002 were identified from the Swedish Vascular Registry (Swedvasc). Of these, 190 patients were re-examined by ultrasonography after a median of 7 (range 2·9-18·7) years.Results:The number of patients with at least one aneurysm in addition to the PAA was 108 (56·8 per cent) at the index operation and 131 (68·0 per cent) at re-examination. The overall number of aneurysms increased by 41·8 per cent, from 244 to 346. Among the 82 patients who had an isolated PAA at the index operation, 23 developed a new aneurysm; these patients tended to be older (P = 0·004). Bilateral PAA at the index operation was associated with a later development of abdominal aortic aneurysm (P = 0·004). Age (P = 0·004) and hypertension (P = 0·012) at the time of the index operation were associated with multianeurysm disease at any time. Six (4·3 per cent) of 138 legs treated by venous bypass grafts had developed a graft aneurysm by the time of re-examination. No normal arterial segment developed an aneurysm that required surgery within 3 years.Conclusion:The development of new aneurysms was common in patients with a PAA; lifelong surveillance may be warranted.

Place, publisher, year, edition, pages
2008. Vol. 95, no 5, 571-575 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96057DOI: 10.1002/bjs.6074ISI: 000255794100007PubMedID: 18306151OAI: oai:DiVA.org:uu-96057DiVA: diva2:170503
Available from: 2007-09-06 Created: 2007-09-06 Last updated: 2017-12-14Bibliographically 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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