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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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