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The Journal of Cardiovascular Surgery 1998 April;39(2):137-40

language: English

Occlu­sive dis­ease asso­ciated ­with pop­li­teal aneu­rysms: impact on ­long ­term ­graft ­patency

Borowicz M. R., Robison J. G., Elliott B. M., Brothers T. E., Robinson C. K.

From the Sec­tion of Vas­cular Sur­gery Depart­ment of Sur­gery Med­ical Uni­ver­sity of ­South Car­o­lina, ­Charleston, SC, USA


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Objec­tive. Cor­re­late ­graft ­patency and ­limb sal­vage out­comes fol­lowing pop­li­teal aneu­rysm ­repair ­with the ­extent of ­tibial occlu­sive dis­ease.
Experi­mental ­design. Ret­ro­spec­tive ­study ­with a ­mean ­follow-up of 36 ­months (­range, 2-96 ­months).
Set­ting. Insti­tu­tional ­teaching hos­pital.
­Patients. Of 20 pop­li­teal aneu­rysms ­among 16 ­patients under­going ­repair, 75% ­were asso­ciated ­with pre­op­er­a­tive ­tibial ­vessel occlu­sion. ­Normal, ­three ­vessel infra­pop­li­teal ­runoff was ­present in 5 ­patients, two ves­sels in 7 ­patients, and one or no ves­sels in 8 ­patients. ­Fifty per­cent of ­limbs ­were asymp­to­matic, ­while the ­remainder suf­fered ­from a ­variety of ­ischemic symp­toms.
Inter­ven­tions. ­Eighteen of the 20 aneu­rysms ­were ­repaired ­with femor­o­pop­li­teal ­bypass ­grafts, and two ­femoral-­tibial ­bypasses ­were per­formed. Autog­e­nous saph­e­nous ­vein was ­used in 18 ­cases (10 in ­situ, 8 ­reversed) and ­PTFE in two ­short seg­ment ­femoral-pop­li­teal ­bypasses.
Meas­ures. ­Graft ­patency was deter­mined by pres­ence of a pal­pable ­pulse, the re-estab­lish­ment of ­normal ­ankle-bra­chial ­indices, or ­duplex scan­ning. ­Patency and ­limb sal­vage ­rates ­were esti­mated ­using ­life ­table anal­ysis by the ­Kaplan-­Meier ­method.
­Results. Pre­op­er­a­tive symp­toms did not cor­re­late ­with ­tibial ­runoff, ­except in two ­patients pre­senting ­with ­acute throm­bosis and ­ischemia. Cumu­la­tive ­graft ­patency by ­life ­table anal­ysis was not dif­ferent for ­either ­good (2-3 ves­sels, N-12) or ­poor (0-1 ves­sels, N-8) ­runoff. ­Overall pri­mary ­patency at 60 ­months was 73%, and cumu­la­tive sec­on­dary ­patency was 100% ­with no ­limbs ­lost at 60 ­months.
Con­clu­sions. Con­com­i­tant ­distal arte­rial occlu­sive dis­ease is fre­quently asso­ciated ­with pop­li­teal aneu­rysms, yet did not ­appear to sub­stan­tially ­impact ­either ­long-­term ­graft ­patency or ­limb sal­vage.

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