Department of Vascular Surgery, Centre Hospitalier du Valais Romand, Switzerland.
Department of Vascular Surgery, Centre Hospitalier du Valais Romand, Switzerland.
Ann Vasc Surg. 2022 Oct;86:482-489. doi: 10.1016/j.avsg.2022.06.012. Epub 2022 Jul 9.
Expansion after popliteal artery aneurysm exclusion with bypass is a common phenomenon. Popliteal angiosarcoma is seldom reported in literature and in most cases after popliteal artery aneurysm surgery. This paper aims to present the case of a popliteal angiosarcoma, initially diagnosed as late aneurysmal growth after exclusion surgery, to conduct a systematic review of popliteal angiosarcoma and assess any association between angiosarcoma and previous popliteal aneurysm surgery.
We performed a secondary popliteal aneurysmorraphy through posterior approach for symptomatic aneurysm expansion in a 79-year-old woman, 9 years after medial femoropopliteal venous bypass and aneurysm exclusion. The postoperative course was complicated by recurrent hematomas and wound spillages requiring multiple revisions. Pathological analysis identified an angiosarcoma. Staging revealed bone invasion and pulmonary metastasis. Despite transfemoral amputation and adjuvant chemotherapy the patient died 8 months later. We performed a systematic review through MEDLINE on 'primary' and 'secondary' (with previous vascular surgery) angiosarcoma in popliteal artery aneurysm. Research was done using the terms '(hem) angiosarcoma', 'aneurysm', 'popliteal aneurysm or artery', 'femoral aneurysm or artery'. Other soft tissue sarcoma or nonpopliteal locations were excluded.
Including this case, only 13 angiosarcomas in popliteal aneurysms are currently described. Two were reported without previous surgery considered as primary angiosarcoma and 11 after popliteal artery aneurysm surgery (secondary angiosarcoma). Patient age ranges from 8 months to 83 years with a male predominance (10/3). Nine of the 11 patients with secondary angiosarcoma were initially diagnosed as popliteal aneurysm expansion after previous bypass surgery, the 2 other secondary cases presented respectively with pain and inflammatory syndrome without expansion. All prior surgical exclusion was carried out by a medial approach. Interval with the index operation ranges from 3 months to 15 years. Death was reported in 8 of the 13 cases within the first year of diagnosis.
Although seldom reported, popliteal angiosarcomas are mainly described after popliteal artery aneurysm exclusion surgery, raising suspicion on a potential association, yet causality cannot be demonstrated. Angiosarcoma should be included in the differential diagnosis of popliteal aneurysm growth or unexpected outcome after exclusion bypass surgery. Systematic imaging and pathological studies should be undertaken to allow early diagnosis and treatment. Routine use of a posterior approach, with aneurysm resection, when feasible as initial popliteal artery aneurysm treatment, might reduce the risk of late sarcomatous transformation.
腘动脉动脉瘤切除后再扩张伴旁路是一种常见现象。文献中很少报道腘动静脉肉瘤，且大多数发生在腘动脉动脉瘤手术后。本文旨在报道一例腘动静脉肉瘤，最初诊断为排除手术后晚期动脉瘤生长，对腘动静脉肉瘤进行系统评价，并评估动静脉肉瘤与先前的腘动脉动脉瘤手术之间的任何关联。
我们对 1 例 79 岁女性进行了二次腘动脉瘤切除术，该患者在股腘静脉旁路和动脉瘤排除 9 年后，因症状性动脉瘤扩张而行手术。术后过程复杂，反复出现血肿和伤口溢出，需要多次修正。病理分析确定为血管肉瘤。分期显示骨侵犯和肺转移。尽管进行了经股截肢和辅助化疗，患者仍在 8 个月后死亡。我们通过 MEDLINE 对“原发性”和“继发性”（有先前血管手术）腘动脉动脉瘤中的动静脉肉瘤进行了系统评价。研究使用了“（hem）angiosarcoma”、“aneurysm”、“popliteal aneurysm or artery”、“femoral aneurysm or artery”等术语。排除了其他软组织肉瘤或非腘部位置。
包括本病例在内，目前仅描述了 13 例发生在腘动脉瘤中的动静脉肉瘤。其中 2 例报告为无先前手术的原发性动静脉肉瘤，11 例为腘动脉动脉瘤手术后（继发性动静脉肉瘤）。患者年龄从 8 个月到 83 岁不等，男性居多（10/3）。11 例继发性动静脉肉瘤患者中，有 9 例最初诊断为旁路手术后的腘动脉瘤扩张，另外 2 例继发性动静脉肉瘤患者分别表现为疼痛和炎症综合征，无扩张。所有先前的手术排除均采用内侧入路进行。与指数手术的间隔时间为 3 个月至 15 年。在 13 例病例中，有 8 例在诊断后的第一年死亡。
尽管很少报道，但腘动静脉肉瘤主要发生在腘动脉动脉瘤排除手术后，引起对潜在关联的怀疑，但不能证明因果关系。在排除旁路手术后的腘动脉瘤生长或意外结果的鉴别诊断中应考虑动静脉肉瘤。应进行系统的影像学和病理学研究，以实现早期诊断和治疗。作为初始腘动脉动脉瘤治疗，当可行时，采用后路切除动脉瘤，常规使用后入路，可能会降低晚期肉瘤转化的风险。
