Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm.

Jungi, Silvan; Kuemmerli, Christoph; Kissling, Pascal; Weiss, Salome; Becker, Daniel; Schmidli, Jürg; Wyss, Thomas R. (2019). Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm. European journal of vascular and endovascular surgery EJVES, 57(3), pp. 393-398. Elsevier 10.1016/j.ejvs.2018.09.030

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OBJECTIVE/BACKGROUND Acute ischaemia due to thrombosed popliteal artery aneurysm (PAA) is associated with a high risk of limb loss. The aim of this study was to analyse the outcome, in particular the limb salvage rate in patients undergoing urgent open surgery for acute ischaemia due to thrombosed PAA. METHODS This was a retrospective analysis of consecutive patients undergoing urgent open surgery for acute limb ischaemia (Rutherford category ≥ II) due to thrombosed popliteal artery aneurysm between January 2007 and December 2016 at a tertiary referral centre. RESULTS Fifty-one patients (92% male), median age 75 years (range 46-97 years), were identified. Twenty patients (39%) presented with category IIa acute limb ischaemia, 20 (39%) with category IIb, and 11 (22%) with category III. Four patients (8%) underwent primary major amputation. Forty-seven (92%) underwent bypass surgery, 43/47 (91%) using great saphenous vein. One vessel runoff was present in 27/47 patients (57%). Thirty day mortality was 4% (n = 2). Four patients needed major amputation within 30 days, resulting in an overall 30 day major amputation rate of 16% (8/51, 95% confidence interval 7.0-28.6). No further major amputations were necessary during a median follow up of 41 months (range 4-114 months) resulting in an estimated 4 year limb salvage of 84%. The one year primary assisted and secondary bypass patency rates were 90% and 95%, respectively. The estimated four year primary assisted and secondary patency rates were 82% and 87%, respectively. CONCLUSION Rapid open surgical revascularisation in patients with acute limb ischaemia due to a thrombosed popliteal artery aneurysm results in good long-term limb salvage rates, especially Rutherford category IIa and IIb acute ischaemia. Revascularisation may be attempted in clinically severe cases not fulfilling all criteria to be classified as category III. Such patients may, in fact, be borderline between IIb and III. Despite poor runoff, good bypass patency rates and low rates of claudication can be achieved.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Jungi, Silvan; Weiss, Salome; Becker, Daniel; Schmidli, Jürg and Wyss, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1078-5884

Publisher:

Elsevier

Language:

English

Submitter:

Daniela Huber

Date Deposited:

08 Jan 2019 16:31

Last Modified:

14 May 2020 16:39

Publisher DOI:

10.1016/j.ejvs.2018.09.030

PubMed ID:

30393064

Uncontrolled Keywords:

Acute limb ischaemia Popliteal artery aneurysm Popliteal artery aneurysm thrombosis Revascularisation for acute limb ischaemia Thrombolysis

BORIS DOI:

10.7892/boris.123091

URI:

https://boris.unibe.ch/id/eprint/123091

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