Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm
Abstract Background Popliteal 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 exper...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00514-7 |
| _version_ | 1797453472286638080 |
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| author | Sara Pomatto Gianluca Faggioli Rodolfo Pini Ilaria Ficarelli Alessia Pini Cecilia Angherà Cristina Rocchi Stefania Caputo Andrea Vacirca Carlo Ruotolo Mauro Gargiulo |
| author_facet | Sara Pomatto Gianluca Faggioli Rodolfo Pini Ilaria Ficarelli Alessia Pini Cecilia Angherà Cristina Rocchi Stefania Caputo Andrea Vacirca Carlo Ruotolo Mauro Gargiulo |
| author_sort | Sara Pomatto |
| collection | DOAJ |
| description | Abstract Background Popliteal 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. Methods All 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. Results Sixty-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]. Conclusions PAA 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. |
| first_indexed | 2024-03-09T15:23:20Z |
| format | Article |
| id | doaj.art-521e842cf81e4eefa56c04517012a981 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-03-09T15:23:20Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-521e842cf81e4eefa56c04517012a9812023-11-26T12:40:40ZengBMCWorld Journal of Emergency Surgery1749-79222023-10-011811910.1186/s13017-023-00514-7Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysmSara Pomatto0Gianluca Faggioli1Rodolfo Pini2Ilaria Ficarelli3Alessia Pini4Cecilia Angherà5Cristina Rocchi6Stefania Caputo7Andrea Vacirca8Carlo Ruotolo9Mauro Gargiulo10Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. OrsolaDivision of Vascular Surgery, Cardarelli HospitalVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaDivision of Vascular Surgery, Cardarelli HospitalVascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna “Alma Mater Studiorum” - DIMEC, Policlinico S. OrsolaAbstract Background Popliteal 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. Methods All 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. Results Sixty-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]. Conclusions PAA 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.https://doi.org/10.1186/s13017-023-00514-7Popliteal artery aneurysmUrgentSurgical treatmentThrombolysisAcute limb ischemiaRupture |
| spellingShingle | Sara Pomatto Gianluca Faggioli Rodolfo Pini Ilaria Ficarelli Alessia Pini Cecilia Angherà Cristina Rocchi Stefania Caputo Andrea Vacirca Carlo Ruotolo Mauro Gargiulo Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm World Journal of Emergency Surgery Popliteal artery aneurysm Urgent Surgical treatment Thrombolysis Acute limb ischemia Rupture |
| title | Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| title_full | Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| title_fullStr | Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| title_full_unstemmed | Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| title_short | Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| title_sort | limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm |
| topic | Popliteal artery aneurysm Urgent Surgical treatment Thrombolysis Acute limb ischemia Rupture |
| url | https://doi.org/10.1186/s13017-023-00514-7 |
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