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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 1999 September;6(3):187-97

language: English, Italian

Preoperative ­intra-arte­ri­al throm­bol­y­sis in pop­li­teal ­artery aneu­rysms com­pli­cat­ed by ­acute throm­bo­sis. Long-­term ­results

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.

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