腘动脉瘤：择期修复与急诊修复的疗效比较

Popliteal artery aneurysms: a comparison of outcomes in elective versus emergent repair.

作者信息

Aulivola Bernadette, Hamdan Allen D, Hile Chantel N, Sheahan Malachi G, Skillman John J, Campbell David R, Scovell Sherry D, LoGerfo Frank W, Pomposelli Frank B

机构信息

Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5B, Boston, MA 02215, USA.

出版信息

J Vasc Surg. 2004 Jun;39(6):1171-7. doi: 10.1016/j.jvs.2003.12.023.

DOI:10.1016/j.jvs.2003.12.023

PMID:15192554

Abstract

OBJECTIVE

The purpose of this study was to assess and compare outcomes of elective versus emergent operative repair of popliteal artery aneurysms.

DESIGN

A retrospective analysis of a prospectively recorded vascular surgery database from June 1992 to December 2002 was performed with chart review. Main outcome measures Patient survival, limb salvage, and graft patency were evaluated.

RESULTS

Fifty-one popliteal artery aneurysms were repaired in 39 patients, all male and ranging in age from 18 to 87 years (mean 67.1). Mean follow-up was 47.8 months. Repair was elective in 37 (72.5%) and emergent in 14 (27.5%) limbs, 13 with acute ischemia and one with aneurysm rupture. Thrombolytic therapy was utilized in four ischemic limbs with no suitable bypass target vessel identified on initial arteriogram. Outflow vessels included the popliteal artery in 22 (43.1%) and infrapopliteal vessels in 29 (56.9%) limbs. Cardiac morbidity and 30-day mortality rates were 0%. Overall primary patency, secondary patency, limb salvage, and actuarial survival were 95.6%, 100%, 98.0%, and 98.0% at 1 year and 85.1%, 96.9%, 98.0%, and 83.8% at 5 years, respectively. Bypass graft redo or revision was performed for stenosis in one and occlusion in four limbs. Two amputations were performed at 6 days and 63.6 months after initial aneurysm repair. No difference was noted between elective and emergent groups with regard to patency, limb salvage, or survival (P >.26), and no association between the number of identified target vessels and limb salvage or patency was demonstrated (P =.12).

CONCLUSION

In our experience, the outcome of the popliteal artery aneurysm repair was comparable in the emergent and elective settings. Aggressive tibial reconstruction plays a crucial role in the treatment of popliteal artery aneurysms, especially in those presenting with acute limb ischemia. Thrombolytic therapy is infrequently required in the acute setting, although it may be useful in patients with no identifiable outflow target vessel on initial arteriogram.

摘要

目的

本研究旨在评估和比较腘动脉动脉瘤择期手术修复与急诊手术修复的效果。

设计

对1992年6月至2002年12月前瞻性记录的血管外科数据库进行回顾性分析，并查阅病历。主要观察指标评估患者生存率、肢体挽救率和移植物通畅率。

结果

39例患者共修复51个腘动脉动脉瘤，均为男性，年龄18至87岁（平均67.1岁）。平均随访47.8个月。37条肢体（72.5%）为择期修复，14条肢体（27.5%）为急诊修复，其中13条肢体急性缺血，1条肢体动脉瘤破裂。4条缺血肢体因初始血管造影未发现合适的旁路目标血管而采用溶栓治疗。流出血管包括22条肢体（43.1%）的腘动脉和29条肢体（56.9%）的腘下血管。心脏发病率和30天死亡率为0%。1年时总体原发性通畅率、继发性通畅率、肢体挽救率和精算生存率分别为95.6%、100%、98.0%和98.0%，5年时分别为85.1%、96.9%、98.0%和83.8%。1条肢体因狭窄、4条肢体因闭塞进行了旁路移植术再次手术或翻修。初次动脉瘤修复后6天和63.6个月分别进行了2次截肢。在通畅率、肢体挽救率或生存率方面，择期组和急诊组之间未发现差异（P>.26），且未证明已识别的目标血管数量与肢体挽救率或通畅率之间存在关联（P =.12）。