ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2001 December;8(4):265-73

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English, Italian

Coexisting femoral, popliteal and aortic aneurysms. Surgical timing

Costa P., Marchetti T., Accrocca F., Gossetti B., Irace L., Benedetti-Valentini F.

From the 2nd Department of Vascular Surgery “La Sapienza” University of Rome, Rome

Background. Over the ­past few ­years aneu­rysms ­have ­been ­found ­more fre­quent­ly in sev­er­al arte­ri­al dis­tricts in the ­same ­patient ­owing to the exten­sive use of non-inva­sive diag­nos­tic meth­ods. The coex­is­tence of aneu­rysms asso­ciat­ed ­with the abdom­i­nal aor­ta and ­with periph­er­al ves­sels in the low­er ­limbs some­times rais­es prob­lems of sur­gi­cal tim­ing.
Methods. From April 1992 to April 1999 27 ­patients ­were diag­nosed ­with coex­ist­ing dil­a­ta­tion of the abdom­i­nal aor­ta (trans­verse diam­e­ter >3.5 cm) and a femo­ral aneu­rysm (FA) or pop­li­teal aneu­rysm (PA). Thirteen ­patients under­went tra­di­tion­al sur­gery to cor­rect ­both abdom­i­nal aor­tic aneu­rysm (AAA) and periph­er­al aneu­rysm. In 11 cas­es aor­tic treat­ment pre­ced­ed treat­ment of the periph­er­al aneu­rysm, where­as in the remain­ing 2 cas­es PA was oper­at­ed ­first due to rup­ture.
Results. The ­mean dura­tion of fol­low-up was 35 ­months (4-82 ­months). Porioperative mor­tal­ity was ­zero. No occlu­sions of aor­to-aor­tic, aor­toi­liac or aor­to-femo­ral bypass­es ­were report­ed. No throm­bos­es ­occurred in PA ­after AAA sur­gery. Overall paten­cy at 3 ­years was 86%.
Conclusions. Surgical tim­ing ­depends on the dimen­sions and char­ac­ter­is­tics of the aneu­rys­mat­ic sac, the over­all symp­toms and the ­risk of com­pli­ca­tions. Except in emer­gen­cy cas­es, pri­or­ity ­must be giv­en to AAA, ­although PA ­requires cor­rec­tion short­ly ­after. In our expe­ri­ence, the ­first oper­a­tion did not influ­ence the ­results of the sec­ond.