PDF(Pubmed)
Abstract：
Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo-popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3-78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo-popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient\'s overall condition should be considered.
摘要：
背景/目的：传统上，pop动脉动脉瘤（PAA）是通过开放的PAA修复（OPAR）与pop静脉移植物介入治疗的。尽管在选择性病例中报告了优异的结果，在紧急情况下或需要辅助程序的情况下，结果要差得多。本研究旨在确定可能降低无截肢生存率（疗效终点）和降低移植物通畅性（技术终点）的风险因素。患者和方法：从2000年到2021年进行了双中心回顾性分析，涵盖了所有连续的PAA修复，对选择性和紧急修理,考虑到患者(即，年龄和合并症)，PAA(即，直径和胫骨径流血管)，和程序特征(即，程序时间,材料,和旁路配置)。描述性的,单变量，并使用多元统计。结果：316例患者（69.8±10.5年），395PAA（平均直径31.9±12.9mm）进行了手术，67作为紧急程序（6×破裂；93.8％严重急性肢体缺血）。大多数人接受了OPAR（366次手术）。急诊患者术前和术后胫骨径流较差，更长的手术时间，和更复杂的重建包含各种辅助程序以及更多的医疗和手术并发症（所有p<0.001）。总的来说,院内截肢率和死亡率分别为3.6%和0.8%，分别。中位随访时间为49个月。五年原发性和继发性通畅率分别为80％和94.7％。静脉移植物的通畅性优于同种异体和复合重建（p<0.001），但平均手术时间延长了51.4（24.3-78.6）分钟（p<0.001）。选择性手术后无截肢生存率显著改善(p<0.001)，但仅在早期（住院）阶段。患者年龄的增加和任何医疗并发症都是显着的负面预测因素，不管动脉瘤大小.结论：尽管选择性和紧急PAA修复的手术时间可能更长，但pop静脉介入仍然是治疗的金标准。确定最有效的治疗策略为老年和可能是脆弱的患者，应考虑动脉瘤大小和患者的总体状况等因素。
