Spectrum Health Grand Rapids, Michigan State University, College of Human Medicine, Grand Rapids, MI.
Spectrum Health Grand Rapids, Michigan State University, College of Human Medicine, Grand Rapids, MI.
Ann Vasc Surg. 2021 Apr;72:665.e9-665.e13. doi: 10.1016/j.avsg.2020.10.018. Epub 2020 Nov 21.
A previously repaired right popliteal artery aneurysm via a medial approach with proximal and distal ligation and interval bypass re-presented 7 years after the initial repair with a ruptured 9 × 25.5 cm right popliteal aneurysm.
Surgical repair was complex due to the large size of the aneurysm. Technique and management of popliteal aneurysm repair are discussed, along with a review of the current literature.
A 58-year-old male with a 3.5 cm popliteal artery aneurysm was initially treated with end-to-end prosthetic bypass and proximal/distal aneurysm ligation from a medial-approach without complication. Seven years later, he presented with a 9-cm popliteal aneurysm rupture. Posterior approach endoaneurysmorrhaphy repair was far more complicated than expected with massive blood loss. Despite this, he was discharged without complication POD #5, but on POD #19 presented with cellulitis and underwent incision and drainage of retained hematoma with cultures positive for Strep dysgalactiae. With appropriate treatment, he was healed in 3 months.
Surgical repair of large popliteal aneurysms can be challenging, but continued aneurysmal degeneration is a potential consequence if the sac continues to be pressurized from patent geniculate arteries. Surgical repair of large popliteal artery aneurysms is complex and requires adjunctive techniques to maximize success. A posterior approach is described and the literature reviewed to support recommendations for primary popliteal artery aneurysm repair and repair of large degenerated popliteal artery aneurysms. We recommend primary popliteal artery aneurysm repair from a posterior approach with endoaneurysmorrhaphy and an interposition bypass. For ruptured large popliteal artery aneurysms, there is a high risk of hemorrhage and wound complications. Therefore, we recommend the use of a tourniquet, surgical drain and to consider the collection of intraoperative cultures to guide potential antibiotic management.
患者 7 年前曾因右腘动脉动脉瘤在 medial 入路行近端和远端结扎及间隔旁路转流修复，现再次因初次修复后 7 年出现破裂的 9×25.5cm 右腘动脉瘤而就诊。
由于动脉瘤体积较大，手术修复较为复杂。讨论了腘动脉瘤修复的技术和管理，并对当前文献进行了回顾。
一名 58 岁男性，最初因 3.5cm 腘动脉动脉瘤行端端人造旁路和近端/远端动脉瘤结扎治疗，来自 medial 入路，无并发症。7 年后，他出现 9cm 腘动脉瘤破裂。后路血管内动脉瘤修复比预期的要复杂得多，大量失血。尽管如此，他在术后第 5 天无并发症出院，但在术后第 19 天出现蜂窝织炎，并进行切开引流以清除残留血肿，培养结果为链球菌。经过适当治疗，他在 3 个月内痊愈。
大型腘动脉瘤的手术修复可能具有挑战性，但如果囊继续受到通畅的关节动脉的压力，动脉瘤会继续退化。大型腘动脉动脉瘤的手术修复较为复杂，需要辅助技术以最大限度地提高成功率。描述了后路入路并对文献进行了回顾，以支持原发性腘动脉动脉瘤修复和大型退行性腘动脉动脉瘤修复的建议。我们建议从后路进行原发性腘动脉动脉瘤修复，采用血管内动脉瘤修复术和间置旁路术。对于破裂的大型腘动脉瘤，存在严重出血和伤口并发症的风险。因此，我们建议使用止血带、手术引流，并考虑收集术中培养物以指导潜在的抗生素管理。
