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Online ISSN 1827-1847
Palumbo N., Cevolani M., Faggioli G. L., Tedesco A., Leone M.
From the Department of Surgical Science and Anesthesiology Policlinico S. Orsola, Bologna, Italy Bologna University, Italy
Aim. This study aimed to evaluate the influence of preoperative intra-arterial thrombolysis with urokinase on the results of popliteal artery aneurysm (PAA) surgery complicated by acute thrombosis and to identify the predictive factors for successful surgical revascularisation.
Methods. A retrospective study was made of the evolution of subarticular femoropopliteal bypass operations performed between January 1986 and December 1997 in 60 patients (56 males, 4 females) with 75 PAA. The mean age was 66 years (20-82). The etiology was atheromatous in 73 cases (97%) and mycotic in 2 cases. Aneurysms were divided into 3 groups depending on clinical presentation and the type of treatment. The first group (GI) included 35 uncomplicated aneurysms undergoing elective surgery, the second group (GII) included 27 aneurysms complicated by acute thrombosis and operated in election but after intra-arterial thrombolysis with urokinase; the third group (GIII) comprised 13 aneurysms complicated by acute thrombosis and undergoing emergency surgery. In GI 15 cases were asymptomatic and 20 cases presented signs of chronic ischemia and intermittent claudication. For revascularisation purposes the saphenous vein was used 50 times (67%), an expanded polytetrafluoroethylene (PTFE) graft was used 23 times and dardik in 2 cases. Lumbar sympathectomy was associated with revascularisation in 8 cases. The mean follow-up for GI was 48 months (1-112 months), for GII 46 months (1-120).
Results. The results were obtained using the actuarial method. There were no early thromboses in GI, one occurred in GII and 6 in GIII, with amputation at the thigh in all cases. After 4 years the bypass patency rate and limb salvage rate in GI were respectively 81 and 91%; 78 and 85% in GII and 44 and 54% in GIII. Postoperative mortality was nil in GI, and 1 case in GII and GIII. The following factors contributed significantly to bypass patency and limb salvage: the duration of acute ischemia (p<0.005), aneurysm permeability (p<0.001) and the existence of at least two patent leg arteries (p<0.002) at the time of surgery. The last two factors were positively influenced by thrombolysis in patients with acute throm-bosis.
Conclusions. The use of preoperative intra-arterial thrombolysis in PAA complicated by acute thrombosis gives good short and long-term results that are better than those achieved using emergency surgery.
language: English, Italian