Popliteal artery aneurysm with acute ischemia in 229 patients. Outcome after thrombolytic and surgical therapy.

Abstract

The aim of this study was to assess the national management and outcome of popliteal artery aneurysm (PAA). In the Swedish National Registry 717 primary operations for PAA on 571 patients were registered prospectively between 1987 and 2002. 235 legs [corrected] presented with acute ischemia. Median age was 70 for men and 75 for women. Immediate surgery was performed in 135 legs, including intraoperative thrombolysis in 32 cases (Immediate Surgery Group, ISG). Pre-operative thrombolysis was performed in 100 legs, followed by acute (<or=24 hours, 41 legs) or elective (59 legs) surgery (Delayed Surgery Group, DSG). DSG had smaller PAA (27 versus 37 mm, p<0.0001) and were younger (67 versus 72 years, p<0.001). Run-off was worse in DSG than in ISG (p<0.001) and improved in 87% after thrombolysis. Amputation-rate was 27% in the ISG and 7% in the DSG, P<0.0001. The ISG required fasciotomy in 30% compared to 11% of the DSG, p=0.0001. Patients in the ISG and DSG differed in their pre-operative characteristics and were selected to the treatment modalities in a complex manner. Preoperative thrombolysis improves run-off.