Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm

World Journal of Emergency Surgery

Research

Ilaria Ficarelli¹  Carlo Ruotolo¹  Rodolfo Pini²  Alessia Pini³  Stefania Caputo³  Sara Pomatto³  Cristina Rocchi³  Cecilia Angherà³  Andrea Vacirca⁴  Mauro Gargiulo⁴  Gianluca Faggioli⁴ 

[1] Division of Vascular Surgery, Cardarelli Hospital, 9 Via A. Cardarelli, 80131, Naples, Italy;Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy;Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy;Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. Orsola, Via Giuseppe Massarenti 9, 40138, Bologna, Italy;Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy;

关键词: Popliteal artery aneurysm;    Urgent;    Surgical treatment;    Thrombolysis;    Acute limb ischemia;    Rupture;    Limb salvage;    Survival;   

DOI  :  10.1186/s13017-023-00514-7

 received in 2023-06-07, accepted in 2023-08-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPopliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. Few data are available in the literature about the treatment results in these scenarios. The aim of the present study was to evaluate an 11-year multicenter experience in the urgent treatment of PAAs.MethodsAll symptomatic PAAs surgically treated in two vascular centers between 2010 and 2021 were retrospectively analyzed. In the postoperative period periodical clinical and Duplex-Ultrasound evaluation were performed. The evaluated endpoint was the outcome of urgent PAAs treatment according to their clinical presentation. Statistical analysis was performed by Kaplan-Meier log-rank evaluation and multivariable Cox regression tests.ResultsSixty-six PAAs needed an urgent repair. Twelve (18%) patients had a PAA rupture and 54 (82%) had an acute limb ischemia (ALI) due to either distal embolization or acute thrombosis. Patients with ALI underwent bypass surgery in 51 (95%) cases, which was associated with preoperative thrombolysis in 18 (31%) cases. A primary major amputation was performed in 3 (5%) cases. The mean follow-up was 52 ± 21 months with an overall 5-year limb salvage of 83 ± 6%. Limb salvage was influenced only by the number of patent tibial arteries (pTA) [5-years limb salvage 0%, 86 ± 10%, 92 ± 8% and 100% in case of 0, 1, 2 or 3 pTA, respectively (P = .001)]. An independent association of number of pTA and limb loss was found [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03–0.6), P = .001]. Overall 5-year survival was 71 ± 7%. Ruptured PAAs were associated with lower 5-year survival compared with the ALI group (48 ± 2% vs. 79 ± 7%, P = .001). The number of pTA (33 ± 20%, 65 ± 10%, 84 ± 10% and 80 ± 10% for 0, 1, 2 and 3 pTA, respectively, P = .001) and the thrombolysis (94 ± 6% vs. 62 ± 10%, P = .03) were associated with higher survival in patients with ALI. There was an independent association of number of pTA and long-term survival [HR 0.15 (95% CI 0.03–0.8), P = .03].ConclusionsPAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and it is associated with lower long-term survival. ALI can benefit from thrombolysis, and long-term limb salvage and survival are associated with the number of pTA.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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