Hans-Christian Arne Stroth, Floris Berg, Hannah Emilia Freytag, Christian Reeps, Steffen Wolk, Ralf-Thorsten Hoffmann, Heiner Nebelung, Jens-Peter Kühn, Albert Busch, Marvin Kapalla
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引用次数: 0
Abstract
Background: Patients having emergency surgery due to ischemia caused by a popliteal artery aneurysm (PAA) have worse outcomes in all endpoints (operation time, major adverse limb events (MALE), amputation-free survival) than after elective treatment, mostly due to a limited crural vessel runoff. This study investigates the relationship between PAA diameter, volume, and luminal thrombus load in relation to the preoperative crural runoff. Patients and methods: Retrospective single-centre evaluation of surgically treated patients with PAA and semi-automated quantitative CT analysis of PAA morphologies (diameter, volume and intraluminal thrombus volume). Primary endpoints were the correlations these characteristics with the number of patent crural vessels. Results: A total of 89 PAAs (61 patients, median age 75, IQR 12; 94.4% male) were identified, of which 47.2% were symptomatic with 18 acute limb ischemia (ALI). The diameter at surgery was 33.8 ± 12.1mm and the volume 68.5 ± 13.6mm3. A median of two lower leg vessels were patent (elective 3 [1, 2, 3] vs. emergency 1 [1, 2], p=0.1) upon preoperative CTA. 77 PAAs underwent elective surgery, five PAAs (5.6%) received endovascular treatment. The surgical complication rate was 23.6% without immediate or early occlusion. The follow-up was 42.5 [39-45] months. The overall mortality rate was 11.2% and the primary patency rate 73.9%. While the total aneurysm volume correlated well with the diameter (r=0.77, p<0.01), the intraluminal thrombus volume (ILT) showed the clearest correlation with the crural runoff (r=-0.34, p=0.01). No correlation between the diameter and crural runoff was observed (r=-0.17, p=0.1). A reduced crural run-off was significantly associated with impaired amputation-free survival (p=0.01). A subgroup analysis (n=21) with sequential CTs showed a tendency towards greater increase of thrombus volume compared to plain diameter during PAA growth. The thrombus volume index (=ILT/total PAA volume) was significantly higher in emergency patients (p=0.01), while diameters tended to be smaller (p=0.57). Conclusions: The increasing intraluminal thrombus volume correlates most distinctly with a reduced crural runoff in PAAs and should therefore be considered prognostically important, especially in the presence of an increased growth rate compared to the diameter.
期刊介绍:
Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology.
The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation.
Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.