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Abstract
Background. Popliteal artery aneurysm (PAAs) is the most common periphereal artery aneurysm, but thromboembolic complications may result in limb loss. The aim of this study was evaluate the management and early outcomes for popliteal aneurysm. Patients and methods. A retrospective review of all patients with popliteal aneurysm between 2016 and 2020. Data collected included findings at presentation, operative details, graft patency, complications, and 30-day mortality.
Results. Twenty-seven limbs were operated on in 25 patients, consisting of 21 (84%) men and 4 (16%) women. Initial findings included 21 (84%) unilateral and 4 (16%) bilateral PAAs with a mean diameter of 35 ± 9 mm. Nine symptomatic patients with, thrombosis (n=4), intermittent claudication (n=2), critical ischemia (n=2), and local pain (n=1). Medial approach was realized in 20 (80%) patients. Proximal and distal ligation with bypass grafting was used in seventh (68%) patients, aneurysmectomy with interposition in eight (32%). Great saphenous vein was used in all cases. The 30-day postoperative mortality was 0%, and two amputations were necessary after failed bypass grafting in emergency patients. Two compartment syndrome, and one deep wound infection were reported. The perioperative 30-day primary patency rate was 86.6%, and secondary patency rate at 6 months was 100%. Conclusion. Results of management of popliteal arterial aneurysm on asymptomatic patients seem better than in emergency cases. Medial approach remains one of the best option for surgical treatment.
RÉSUMÉ
Introduction. Les anévrismes de l’artère poplitée sont les plus fréquents des anévrismes périphériques, et leurs complications thromboemboliques peuvent entrainer une amputation. L’objectif de cette étude est d’évaluer le traitement chirurgical et les suites opératoires. Patients et methods. Il s’agit d’une étude retrospective, incluant tous les patients opérés pour anévrisme de l’artère poplitée entre Juin 2016 et Juin 2020. Les données collectées incluaient ; la clinique, le périopératoire, et la mortalité hospitalière. Résultats. Vingt-sept anévrismes de l’artère poplitée ont été opérés parmi 25 patients, 21 (84%) hommes et 4 (16%) femmes. On notait 21 (84%) unilateral and 4 (16%) bilateral anévrismes poplités, avec un diamètre moyen de 35 ± 9 mm. Neuf patients étaient symptomatiques avec, thrombose (n=4), claudication intermittente (n=2), ischémie aigué (n=2), douleurs (n=1). L’abord médial a été réalisé chez 20 (80%) patients. Ligature proximale et distale associée à une pontage a représenté dans 68%, et la mise à plat plus greffe dans 32%. La veine grande a été le principal greffon utilisé. La mortalité hospitalière était nulle ; amputations ont été réalisées après occlusion du greffon chez deux patients opérés en urgence. Deux cas de syndrome de loges ont été rapportés ; avec une infection du site d’anastomose. La perméabilité primaire des trente premiers jours était de 86.6%, et la perméabilité secondaire à 6 mois était de 100%. Conclusion. Les résultats de la chirurgie des anévrismes de l’artère poplitée chez les patients asymptomatiques par rapport aux urgences. L’abord médial reste une des meilleures options de la chirurgie.
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References
- Dawson I, Sie RB, Van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg 1997 ;84 :293-9.
- Dent TL, Lindenauer SM, Ernst CB, Fry WJ. Multiple arteriosclerotic arterial aneurysms. Arch Surg 1972 ;105 :338-44.
- Evans WE, Conley JE, Bernhard VM. Popliteal aneurysms. Surgery 1971 ;70 :762-7.
- ?
- Aulivola B, Hamdan AD, Hile CN et al. Popliteal artery aneurysms : a comparison of outcomes in elective versus emergent repair. J Vasc Surg 2004 ;39 :1171-7.
- Mamode N, Scott RN. Graft type for femoro-popliteal bypass surgery. Cochrane Database
- Syst Rev 2000 ; CD001487.
- Beseth BD, Moore WS. The posterior approach for repair of popliteal artery aneurysms. J Vasc Surg 2006 ;43 :940-5.
- Van Bockel JH, Hamming JF. Lower extremity aneurysms. In: Rutherford RB, editor. Vascular surgery. 6th ed. Philadelphia, PA : Elservier ; 2005. p. 1534-51.
- Rutherford RB, Baker DJ, Ernst C, Johnson WK, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia : revised version. J Vasc Surg 1997 ;26 :517-38.
- Mahmood A, Salaman R, Sintler M, et al. Surgery of popliteal artery aneurysms : a 12-year experience. J Vasc Surg 2003 ;37 :586-93.
- Taurino M, Calisti A, Grossi R, et al. Outcome of early treatment of popliteal artery aneurysms. Int Angiol 1998 ;17 :28-33.
- Whitehouse WM Jr, Wakefield TW, Graham LM, et al. Limb-threatening potential of arteriosclerotic popliteal aneurysms. Surgery 1983 ;93 :694-9.
- Duffy ST, Colgan MP, Sultan S, et al. Popliteal aneurysms : a 10-year experience. Eur J Vasc Endovasc Surg 1998 ;16 : 218-22.
- m
- Varga ZA, Locke-Edmunds JC, Baird RN. A multicenter study of popliteal aneurysms. Joint Vascular Research Group. J Vasc Surg 1994 ; 20 :171-7.
- Pittathankal AA, Dattani R, Magee TR, Galland RB. Expansion rates of asymptomatic popliteal artery aneurysms. Eur J Vasc Surg 2004 ;27 : 382-4.
- Hands L, Collin J. Infrainguinal aneurysms : Outcome for patient and limb. Br J Surg 1991 ;78 :996-8.
- Blanco E, Serrano-Hernando FJ, Monux G, Vega M, Martin A, Rial R, et al. Operative repair of popliteal aneurysms : effect of factors related to the bypass procedure on outcome. Ann Vasc Surg 2004 ;18 :86-92
- Michaels JA, Galland RB. Management of asymptomatic popliteal aneurysms : the use of a Markov decision tree to determine the criteria for a conservative approach. Eur J Vasc Surg 1993 ;7 :136-43.
- Raffaele Pulli, Walter Dorigo, Aaron Fargion et al. Comparison of Early and Midterm Results of Open and Endovascular Treatment of Popliteal Artery Aneurysms. Ann Vasc Surg 2012 ; 26 : 809–818.
- Marty B, Wicky S, Ris HB, Mueller X, Fischer A, Hayoz D, et al. Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms. J Vasc Surg 2002 ;35 :487-93.
- Dorigo W, Pulli R, Turini F, Pratesi G, Credi G, Innocenti AA, et al. Acute leg ischaemia from thrombosed popliteal artery aneurysms : role of preoperative thrombolysis. Eur J Vasc Endovasc Surg 2002 ;23 : 251-4.
References
Dawson I, Sie RB, Van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg 1997 ;84 :293-9.
Dent TL, Lindenauer SM, Ernst CB, Fry WJ. Multiple arteriosclerotic arterial aneurysms. Arch Surg 1972 ;105 :338-44.
Evans WE, Conley JE, Bernhard VM. Popliteal aneurysms. Surgery 1971 ;70 :762-7.
?
Aulivola B, Hamdan AD, Hile CN et al. Popliteal artery aneurysms : a comparison of outcomes in elective versus emergent repair. J Vasc Surg 2004 ;39 :1171-7.
Mamode N, Scott RN. Graft type for femoro-popliteal bypass surgery. Cochrane Database
Syst Rev 2000 ; CD001487.
Beseth BD, Moore WS. The posterior approach for repair of popliteal artery aneurysms. J Vasc Surg 2006 ;43 :940-5.
Van Bockel JH, Hamming JF. Lower extremity aneurysms. In: Rutherford RB, editor. Vascular surgery. 6th ed. Philadelphia, PA : Elservier ; 2005. p. 1534-51.
Rutherford RB, Baker DJ, Ernst C, Johnson WK, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia : revised version. J Vasc Surg 1997 ;26 :517-38.
Mahmood A, Salaman R, Sintler M, et al. Surgery of popliteal artery aneurysms : a 12-year experience. J Vasc Surg 2003 ;37 :586-93.
Taurino M, Calisti A, Grossi R, et al. Outcome of early treatment of popliteal artery aneurysms. Int Angiol 1998 ;17 :28-33.
Whitehouse WM Jr, Wakefield TW, Graham LM, et al. Limb-threatening potential of arteriosclerotic popliteal aneurysms. Surgery 1983 ;93 :694-9.
Duffy ST, Colgan MP, Sultan S, et al. Popliteal aneurysms : a 10-year experience. Eur J Vasc Endovasc Surg 1998 ;16 : 218-22.
m
Varga ZA, Locke-Edmunds JC, Baird RN. A multicenter study of popliteal aneurysms. Joint Vascular Research Group. J Vasc Surg 1994 ; 20 :171-7.
Pittathankal AA, Dattani R, Magee TR, Galland RB. Expansion rates of asymptomatic popliteal artery aneurysms. Eur J Vasc Surg 2004 ;27 : 382-4.
Hands L, Collin J. Infrainguinal aneurysms : Outcome for patient and limb. Br J Surg 1991 ;78 :996-8.
Blanco E, Serrano-Hernando FJ, Monux G, Vega M, Martin A, Rial R, et al. Operative repair of popliteal aneurysms : effect of factors related to the bypass procedure on outcome. Ann Vasc Surg 2004 ;18 :86-92
Michaels JA, Galland RB. Management of asymptomatic popliteal aneurysms : the use of a Markov decision tree to determine the criteria for a conservative approach. Eur J Vasc Surg 1993 ;7 :136-43.
Raffaele Pulli, Walter Dorigo, Aaron Fargion et al. Comparison of Early and Midterm Results of Open and Endovascular Treatment of Popliteal Artery Aneurysms. Ann Vasc Surg 2012 ; 26 : 809–818.
Marty B, Wicky S, Ris HB, Mueller X, Fischer A, Hayoz D, et al. Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms. J Vasc Surg 2002 ;35 :487-93.
Dorigo W, Pulli R, Turini F, Pratesi G, Credi G, Innocenti AA, et al. Acute leg ischaemia from thrombosed popliteal artery aneurysms : role of preoperative thrombolysis. Eur J Vasc Endovasc Surg 2002 ;23 : 251-4.