背景:在急性血栓形成的情况下,需要紧急治疗。远端栓塞,或破裂。文献中关于这些情况下的治疗结果的数据很少。本研究的目的是评估在紧急治疗PAA方面11年的多中心经验。
方法:回顾性分析2010年至2021年在两个血管中心手术治疗的所有有症状的PAAs。在术后期间,进行了定期的临床和双重超声评估。评估的终点是根据其临床表现的紧急PAAs治疗的结果。通过Kaplan-Meier对数秩评估和多变量Cox回归检验进行统计分析。
结果:66个PAA需要紧急修复。由于远端栓塞或急性血栓形成,12例(18%)患者发生PAA破裂,54例(82%)发生急性肢体缺血(ALI)。ALI患者行搭桥手术51例(95%),其中18例(31%)与术前溶栓有关。3例(5%)进行了主要截肢。平均随访时间为52±21个月,总体5年保肢率为83±6%。肢体抢救仅受到胫骨动脉未闭(pTA)数量的影响[5年肢体抢救0%,86±10%,在0、1、2或3pTA的情况下,92±8%和100%,分别(P=.001)]。发现pTA数量和肢体丢失的独立关联[风险比(HR):0.14(95%置信区间(CI)0.03-0.6),P=.001]。5年总生存率为71±7%。与ALI组相比,破裂的PAA与较低的5年生存率相关(48±2%vs.79±7%,P=.001)。pTA的数量(33±20%,65±10%,0、1、2和3pTA分别为84±10%和80±10%,分别,P=.001)和溶栓(94±6%vs.62±10%,P=0.03)与ALI患者的较高生存率相关。pTA数量与长期生存率之间存在独立关联[HR0.15(95%CI0.03-0.8),P=.03]。
结论:在近五分之一的病例中,PAA破裂是紧急治疗的原因,它与较低的长期生存率有关。ALI可以从溶栓中获益,长期保肢和生存率与pTA的数量有关。
Popliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. Few data are available in the literature about the treatment results in these scenarios. The aim of the present study was to evaluate an 11-year multicenter experience in the urgent treatment of PAAs.
All symptomatic PAAs surgically treated in two vascular centers between 2010 and 2021 were retrospectively analyzed. In the postoperative period periodical clinical and Duplex-Ultrasound evaluation were performed. The evaluated endpoint was the outcome of urgent PAAs treatment according to their clinical presentation. Statistical analysis was performed by Kaplan-Meier log-rank evaluation and multivariable Cox regression tests.
Sixty-six PAAs needed an urgent repair. Twelve (18%) patients had a PAA rupture and 54 (82%) had an acute limb ischemia (ALI) due to either distal embolization or acute thrombosis. Patients with ALI underwent bypass surgery in 51 (95%) cases, which was associated with preoperative thrombolysis in 18 (31%) cases. A primary major amputation was performed in 3 (5%) cases. The mean follow-up was 52 ± 21 months with an overall 5-year limb salvage of 83 ± 6%. Limb salvage was influenced only by the number of patent tibial arteries (pTA) [5-years limb salvage 0%, 86 ± 10%, 92 ± 8% and 100% in case of 0, 1, 2 or 3 pTA, respectively (P = .001)]. An independent association of number of pTA and limb loss was found [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03-0.6), P = .001]. Overall 5-year survival was 71 ± 7%. Ruptured PAAs were associated with lower 5-year survival compared with the ALI group (48 ± 2% vs. 79 ± 7%, P = .001). The number of pTA (33 ± 20%, 65 ± 10%, 84 ± 10% and 80 ± 10% for 0, 1, 2 and 3 pTA, respectively, P = .001) and the thrombolysis (94 ± 6% vs. 62 ± 10%, P = .03) were associated with higher survival in patients with ALI. There was an independent association of number of pTA and long-term survival [HR 0.15 (95% CI 0.03-0.8), P = .03].
PAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and it is associated with lower long-term survival. ALI can benefit from thrombolysis, and long-term limb salvage and survival are associated with the number of pTA.