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  • 1.
    Björck, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Ravn, H
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Cervin, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Popliteal artery aneurysm, the importance of life-long suurveillance2010In: 31st Symposium Book: Vascular and Endovascular Controversies Update / [ed] Greenhalgh RM, London: BIBA Publishing , 2010, p. 340-349Chapter in book (Other academic)
  • 2.
    Cervin, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Popliteal Artery Aneurysms: - epidemiology, treatment and results2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Popliteal aneurysms (PA) are limb threatening, since the aneurysm thrombose and emboli from the aneurysm sac occlude the distal vessels, resulting in chronic or acute limb ischaemia. Open surgical repair (OSR) has been challenged by endovascular repair (ER), a minimal invasive technique. Little is known of long-term result, and comparisons of the methods have been difficult, since patients chosen for ER are mainly asymptomatic and have better outflow.

    The overall aim of this thesis was to study epidemiology and risk factors to optimize patient selection and techniques for surgical treatment of PA.

    Papers I and II: Data on all patients treated 2008-2012 (592 PAs in 499 patients) were analysed in the Swedish Vascular registry, Swedvasc. Patency was inferior after ER, in particular for patients with acute ischaemia. Nested in this cohort, a case-control study was performed, and the legs treated by ER (77) were matched, by indication, with twice the number treated with OSR (154). Medical records and radiologic images were collected and examined in a core-lab. In this matched cohort, the only independent risk factors for occlusion were ER and poor outflow. In a sub-group analysis of ER, risk factors for occlusion were acute ischaemia, poor out-flow, smaller stent graft diameter and elongation.

    Paper III: Prevalence of PA was studied in men, screened for abdominal aortic aneurysm (AAA) and of sub aneurysmal aorta, 25-29 mm. Prevalence of PA was high, 14.2%, and correlated with dilatation of the iliac arteries.

    Paper IV: Operations for ruptured PA (rPA) were identified in Swedvasc 1987-2012, medical records were reviewed. Compared with patients treated for other indications, they were 8 years older, had twice as large aneurysms (mean 64 mm) and many were treated with anticoagulants. The initial clinical picture was misleading.

    In conclusion, when treating PA the preferred surgical technique is OSR with a vein graft. Anatomical features of the popliteal artery and outflow vessels affect outcome. These findings are important for future surgical decision making.

    List of papers
    1. Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden
    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
    2. Favourable results after open compared to endovascular repair of popliteal aneurysm: a nested case-control study
    Open this publication in new window or tab >>Favourable results after open compared to endovascular repair of popliteal aneurysm: a nested case-control study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Popliteal artery aneurysm; Endovascular; Open surgery; Stent graft; Occlusion
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-381515 (URN)
    Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10
    3. Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries
    Open this publication in new window or tab >>Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries
    2020 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 1, p. 67-72Article in journal (Refereed) Published
    Abstract [en]

    Background: Data on the prevalence of popliteal artery aneurysm (PA) are scarce and difficult to interpret as the definition differs among papers. The aim was to investigate the prevalence among men with screening detected abdominal aortic aneurysms (>= 30 mm, AAAs) and subaneurysmal aortic dilatation (25-29 mm, SAA), and to explore whether the existence of a PA correlated with the diameters of the aorta, iliac, and femoral arteries.

    Methods: In Uppsala, Sweden, a county with 376 000 inhabitants, AAA screening of 65 year old men was initiated in 2006. All men with AAA and SAA also had measurements of the common iliac artery (CIA). The common femoral (CFA), superficial femoral (SFA), and popliteal arteries were evaluated at re-examination, performed after 1-2 years for AAA and five years for SAA. PA was defined as >= 12 mm, or 1.5 times larger than the distal SFA according to the ISCVS/SVS Ad Hoc Committee. The relationships between PA and other vessel diameters were explored.

    Results: A total of 19 820 65 year old men (84.6%) accepted the invitation to screening between 2006 and 2017. AAA was found in 173 (0.9%), and SAA in 149 subjects (1.1% of those screened 2006-2013, eligible for this study). In the whole cohort, 14.2% of those examined had at least one PA of any size, 3.0% were >= 15 mm and 2.2% >= 20 mm. There was no difference in PA prevalence between AAA and SAA: 15.9% vs. 12.2% (p = .48). There was no difference in aortic diameter in those with or without PA (p = .46), but there were significant correlations with CIA (p < .001), CFA (p < .001), and SFA (p < .001) diameters.

    Conclusions: A high prevalence of PA among subjects with screening detected AAA and SAA was found. PA was not correlated with the aortic diameter in this cohort, where all had dilated aortas, while correlations with peripheral and iliac artery diameters were identified.

    Keywords
    Abdominal aortic aneurysm; Popliteal artery aneurysm; Iliac artery; Screening, Prevalence.
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-381518 (URN)10.1016/j.ejvs.2019.07.042 (DOI)000506204700013 ()31757587 (PubMedID)
    Note

    Title in dissertation list of papers: Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and the prevalence is correlated with the diameters of the common iliac arteries

    Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2020-01-27Bibliographically approved
    4. Ruptured popliteal artery aneurysm
    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
  • 3.
    Cervin, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Acosta, Stefan
    Department of Clinical Sciences Malmö, Lund University.
    Hultgren, Rebecka
    Department of Vascular Surgery, Karolinska University Hospital, Stockholm.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Falkenberg, Mårten
    Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
    Favourable results after open compared to endovascular repair of popliteal aneurysm: a nested case-control studyManuscript (preprint) (Other academic)
  • 4.
    Cervin, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Sahlgrens Univ Hosp, Unit Vasc Surg, Dept Hybrid & Intervent Surg, SE-41345 Gothenburg, Sweden.
    Ravn, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Univ Southern Denmark, Kolding Hosp, Dept Vasc Surg, Kolding, Denmark.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Ruptured popliteal artery aneurysm2018In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 13, p. 1753-1758Article in journal (Refereed)
    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.

  • 5.
    Cervin, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. NU Hosp Org, Trollhattan Uddevalla, Sweden..
    Tjärnstrom, J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. NU Hosp Org, Trollhattan Uddevalla, Sweden..
    Ravn, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Lillebaelt Hosp, Dept Vasc Surg, Lillebaelt, Denmark..
    Acosta, S.
    Malmo Univ Hosp, Vasc Ctr, Malmo, Sweden..
    Hultgren, R.
    Karolinska Inst, Dept Vasc Surg, Stockholm, Sweden..
    Welander, M.
    Linkoping Univ, Dept Vasc Surg, Linkoping, Sweden..
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 50, no 3, p. 342-350Article in journal (Refereed)
    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.

  • 6.
    Cervin, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries2020In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 59, no 1, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Background: Data on the prevalence of popliteal artery aneurysm (PA) are scarce and difficult to interpret as the definition differs among papers. The aim was to investigate the prevalence among men with screening detected abdominal aortic aneurysms (>= 30 mm, AAAs) and subaneurysmal aortic dilatation (25-29 mm, SAA), and to explore whether the existence of a PA correlated with the diameters of the aorta, iliac, and femoral arteries.

    Methods: In Uppsala, Sweden, a county with 376 000 inhabitants, AAA screening of 65 year old men was initiated in 2006. All men with AAA and SAA also had measurements of the common iliac artery (CIA). The common femoral (CFA), superficial femoral (SFA), and popliteal arteries were evaluated at re-examination, performed after 1-2 years for AAA and five years for SAA. PA was defined as >= 12 mm, or 1.5 times larger than the distal SFA according to the ISCVS/SVS Ad Hoc Committee. The relationships between PA and other vessel diameters were explored.

    Results: A total of 19 820 65 year old men (84.6%) accepted the invitation to screening between 2006 and 2017. AAA was found in 173 (0.9%), and SAA in 149 subjects (1.1% of those screened 2006-2013, eligible for this study). In the whole cohort, 14.2% of those examined had at least one PA of any size, 3.0% were >= 15 mm and 2.2% >= 20 mm. There was no difference in PA prevalence between AAA and SAA: 15.9% vs. 12.2% (p = .48). There was no difference in aortic diameter in those with or without PA (p = .46), but there were significant correlations with CIA (p < .001), CFA (p < .001), and SFA (p < .001) diameters.

    Conclusions: A high prevalence of PA among subjects with screening detected AAA and SAA was found. PA was not correlated with the aortic diameter in this cohort, where all had dilated aortas, while correlations with peripheral and iliac artery diameters were identified.

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