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Martin Bjorck - One of the best experts on this subject based on the ideXlab platform.
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ruptured Popliteal Artery Aneurysm
British Journal of Surgery, 2018Co-Authors: Hans Ravn, Anne Cervin, Martin BjorckAbstract:BACKGROUND: Popliteal Artery Aneurysms (PAAs) are generally complicated by thrombosis and distal embolization, whereas rupture is rare. The aim of this study was to describe the clinical characteristics and outcome in a cohort of patients who had surgery for ruptured PAA (rPAA). METHODS: Operations for rPAA were identified from the Swedish Vascular Registry, Swedvasc, 1987-2012. Medical records and imaging were reviewed. Comparison was made with patients treated for PAA without rupture. RESULTS: Forty-five patients with rPAA were identified. The proportion with rupture among those operated on for PAA was 2·5 per cent. Patients with rPAA were 8 years older (77·7 versus 69·7 years; P < 0·001), had more lung and heart disease (P = 0·003 and P = 0·019 respectively), and a larger mean Popliteal Aneurysm diameter (63·7 versus 30·9 mm; P < 0·001) than patients with PAA treated for other indications. At time of surgery, 22 of 45 patients were already receiving anticoagulants, seven for concomitant deep venous thrombosis (DVT) in the affected leg. There was extensive swelling of the whole leg in 20 patients. In 27 patients, the initial diagnosis was DVT or a Baker's cyst. All patients underwent surgery, all but three by the open method. There were four amputations, all performed within 1 week of surgery. One year after surgery, 26 of the 45 patients were alive. Among these, the reconstructions were patent in 20 of 22 patients. CONCLUSION: The diagnosis of rPAA is difficult, and often delayed. The condition affects old patients, who often are on anticoagulation treatment and have large Aneurysms. The immediate surgical results are acceptable, but the condition is associated with a high risk of death within the first year after surgery.
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Popliteal Artery Aneurysm in women
European Journal of Vascular and Endovascular Surgery, 2017Co-Authors: Hans Ravn, Karin Pansellfawcett, Martin BjorckAbstract:Objectives Ninety-five per cent of those operated on for Popliteal Artery Aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women. Methods Women treated for PA in 1987–2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry. Results 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1–7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic Aneurysms, there was a larger proportion of small Aneurysms ( Conclusions PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often
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editor s choice contemporary treatment of Popliteal Artery Aneurysm in eight countries a report from the vascunet collaboration of registries
European Journal of Vascular and Endovascular Surgery, 2014Co-Authors: Martin Bjorck, B Beiles, Gabor Menyhei, Ian Thomson, P Wigger, Maarit Venermo, E Laxdal, G Danielsson, T Lees, Thomas TroengAbstract:Objectives To study contemporary Popliteal Artery Aneurysm (PA) repair. Methods Vascunet is a collaboration of population-based registries in 10 countries: eight had data on PA repair (Australia, Finland, Hungary, Iceland, New Zealand, Norway, Sweden, and Switzerland). Results From January 2009 until June 2012, 1,471 PA repairs were registered. There were 9.59 operations per million person years, varying from 3.4 in Hungary to 17.6 in Sweden. Median age was 70 years, ranging from 66 years in Switzerland and Iceland to 74 years in Australia and New Zealand; 95.6% were men and 44% were active smokers. Elective surgery dominated, comprising 72% of all cases, but only 26.2% in Hungary and 39.7% in Finland, ( p p p Follow-up was until discharge or 30 days. Amputation rate was 2.0% overall: 6.5% after acute thrombosis, 1.0% after endovascular, 1.8% after open repair, and 26.3% after hybrid repair ( p Conclusions Great variability between countries in incidence of operations, indications for surgery, and choice of surgical technique was found, possibly a result of surgical tradition rather than differences in case mix. Comparative studies with longer follow-up data are warranted.
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Popliteal Artery Aneurysm epidemiology and modern management
Acta Chirurgica Belgica, 2009Co-Authors: Hans Ravn, Martin BjorckAbstract:PAA is a predominantly male disease, more than 90% of affected patients are men. Risk factors for amputation are poor run-off, use of a synthetic graft, emergency treatment and high age. The frequency of amputation decreased over time in Sweden, which was associated with increased use of preoperative thrombolysis and fasciotomy. Thrombolysis can transform an emergent into an elective situation, and often improves out-flow. The risk of late amputation is low. Operation with a Posterior approach is associated with lower risk of late expansion, and is considered first choice of treatment when a short by-pass is sufficient. Multiple Aneurysm disease is common among patients with PAA, in particular among those with bilateral PAA. All patients, irrespective of age, should be included in a life-long surveillance program. Normal arterial segments should be re-examined after three years.
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risk of new Aneurysms after surgery for Popliteal Artery Aneurysm
British Journal of Surgery, 2008Co-Authors: Hans Ravn, Anders Wanhainen, Martin BjorckAbstract:Even if Popliteal Artery Aneurysm (PAA) is the most common peripheral Aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the Aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional Aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of Aneurysms increasing by 42% (from 244 to 346).Conclusions: Multiple Aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-Popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed Aneurysms timely. Normal arterial segments should be re-examined after three years.
Hans Ravn - One of the best experts on this subject based on the ideXlab platform.
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ruptured Popliteal Artery Aneurysm
British Journal of Surgery, 2018Co-Authors: Hans Ravn, Anne Cervin, Martin BjorckAbstract:BACKGROUND: Popliteal Artery Aneurysms (PAAs) are generally complicated by thrombosis and distal embolization, whereas rupture is rare. The aim of this study was to describe the clinical characteristics and outcome in a cohort of patients who had surgery for ruptured PAA (rPAA). METHODS: Operations for rPAA were identified from the Swedish Vascular Registry, Swedvasc, 1987-2012. Medical records and imaging were reviewed. Comparison was made with patients treated for PAA without rupture. RESULTS: Forty-five patients with rPAA were identified. The proportion with rupture among those operated on for PAA was 2·5 per cent. Patients with rPAA were 8 years older (77·7 versus 69·7 years; P < 0·001), had more lung and heart disease (P = 0·003 and P = 0·019 respectively), and a larger mean Popliteal Aneurysm diameter (63·7 versus 30·9 mm; P < 0·001) than patients with PAA treated for other indications. At time of surgery, 22 of 45 patients were already receiving anticoagulants, seven for concomitant deep venous thrombosis (DVT) in the affected leg. There was extensive swelling of the whole leg in 20 patients. In 27 patients, the initial diagnosis was DVT or a Baker's cyst. All patients underwent surgery, all but three by the open method. There were four amputations, all performed within 1 week of surgery. One year after surgery, 26 of the 45 patients were alive. Among these, the reconstructions were patent in 20 of 22 patients. CONCLUSION: The diagnosis of rPAA is difficult, and often delayed. The condition affects old patients, who often are on anticoagulation treatment and have large Aneurysms. The immediate surgical results are acceptable, but the condition is associated with a high risk of death within the first year after surgery.
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Popliteal Artery Aneurysm in women
European Journal of Vascular and Endovascular Surgery, 2017Co-Authors: Hans Ravn, Karin Pansellfawcett, Martin BjorckAbstract:Objectives Ninety-five per cent of those operated on for Popliteal Artery Aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women. Methods Women treated for PA in 1987–2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry. Results 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1–7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic Aneurysms, there was a larger proportion of small Aneurysms ( Conclusions PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often
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Popliteal Artery Aneurysm epidemiology and modern management
Acta Chirurgica Belgica, 2009Co-Authors: Hans Ravn, Martin BjorckAbstract:PAA is a predominantly male disease, more than 90% of affected patients are men. Risk factors for amputation are poor run-off, use of a synthetic graft, emergency treatment and high age. The frequency of amputation decreased over time in Sweden, which was associated with increased use of preoperative thrombolysis and fasciotomy. Thrombolysis can transform an emergent into an elective situation, and often improves out-flow. The risk of late amputation is low. Operation with a Posterior approach is associated with lower risk of late expansion, and is considered first choice of treatment when a short by-pass is sufficient. Multiple Aneurysm disease is common among patients with PAA, in particular among those with bilateral PAA. All patients, irrespective of age, should be included in a life-long surveillance program. Normal arterial segments should be re-examined after three years.
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risk of new Aneurysms after surgery for Popliteal Artery Aneurysm
British Journal of Surgery, 2008Co-Authors: Hans Ravn, Anders Wanhainen, Martin BjorckAbstract:Even if Popliteal Artery Aneurysm (PAA) is the most common peripheral Aneurysm, no single surgeon or institution has enough patients to study this disease with appropriate scientific methods, and no population-based investigation exists. PAA epidemiology, treatment, management, and outcome were studied in a population-based study of 571 patients (717 legs) primarily operated on for PAAs and 100 episodes of preoperative thrombolysis in Sweden between 1987 and 2002. Patients were identified in the Swedish Vascular Registry and case-records were reviewed. Information on amputation and survival was obtained for all patients, and 190 patients were re-examined with ultrasound, after mean 7.2 years (range 2-18)Median age was 71 years; 5.8% were women. Patients with unilateral PAA had AAA in 28%, increasing to 38% when PAAs were bilateral. Crude survival was 91.4% at one and 70% at five years, significantly lower than among age and sex matched controls. The cumulative incidence for operation of PAA in Sweden was estimated to 8.3/million person year. One-year amputation-rate was 8.8 %, increasing to 11% after follow-up (7.2 years). Independent risk factors for amputation within one year were poor run-off, age, emergency procedure, and prosthetic graft. Run-off was improved by preoperative thrombolysis among 87% of legs, when acute ischemia. After surgical repair with a medial approach the risk of late expansion of the Aneurysm was 33%, with a posterior approach 8% , p=0.014. Among 190 re-examined patients, 108 (57%) had at least one additional Aneurysm at index-operation, increasing to 131 (68%) at re-examination, the total number of Aneurysms increasing by 42% (from 244 to 346).Conclusions: Multiple Aneurysms are common among patients operated on for PAA. Preoperative thrombolysis improves run-off and decreases the amputation-rate in PAAs with acute ischemia. Vein grafts do better than prosthetic grafts, especially when a long bypass is needed. Posterior approach, when possible, reduces the risk of late expansion. A complete examination of the aorto-iliac and femoro-Popliteal arteries is warranted at the time of surgery. All patients should be kept under life-long surveillance in order to detect and treat newly developed Aneurysms timely. Normal arterial segments should be re-examined after three years.
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Popliteal Artery Aneurysm with acute ischemia in 229 patients outcome after thrombolytic and surgical therapy
European Journal of Vascular and Endovascular Surgery, 2007Co-Authors: Hans Ravn, Martin BjorckAbstract:Objectives The aim of this study was to assess the national management and outcome of Popliteal Artery Aneurysm (PAA). Methods In the Swedish National Registry 717 primary operations for PAA on 571 patients were registered prospectively between 1987 and 2002. 235 patients presented with acute ischemia. Results 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 (≤24 hours, 41 legs) or elective (59 legs) surgery (Delayed Surgery Group, DSG). DSG had smaller PAA (27 versus 37mm, p p p P p =0.0001. Conclusion 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.
Joseph J Ricotta - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes and sac volume shrinkage after endovascular Popliteal Artery Aneurysm repair
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: Michele Piazza, Joseph J Ricotta, Mirko Menegolo, Alessandra Ferrari, Stefano Bonvini, P Frigatti, Franco Grego, Michele AntonelloAbstract:Objectives The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular Popliteal Artery Aneurysm repair (EVPAR). Methods This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan–Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis. Results Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases ( n = 43) the procedure was elective, while in 7% of cases it was for rupture ( n = 2) or acute thrombosis ( n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean Aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p 20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p = .032). Conclusions EVPAR provides successful Aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure.
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endovascular repair of a ruptured giant Popliteal Artery Aneurysm
Perspectives in Vascular Surgery and Endovascular Therapy, 2009Co-Authors: Yevgeniy Rits, Young Erben, Joseph J RicottaAbstract:This report presents the first reported case of an endovascular repair of a ruptured giant Popliteal Artery Aneurysm. The patient, an 86-year-old man, presented emergently with a free rupture of a 7-cm left Popliteal Artery Aneurysm and a large hematoma in his left thigh of approximately 20 cm in diameter. The patient was considered to be at high risk for open surgery and therefore underwent endovascular repair of his ruptured Popliteal Artery Aneurysm using two 8 mm × 15 mm Viabahn endografts. At one month follow-up, the large hematoma in the left thigh had completely resolved, the patient was ambulating without pain or difficulty and had palpable pedal pulses on physical examination. One year following the procedure, the endografts remained patent without endoleak.
Magdy R Moawad - One of the best experts on this subject based on the ideXlab platform.
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endovascular management of ruptured infected Popliteal Artery Aneurysm
Journal of Vascular Surgery, 2012Co-Authors: Mohamed G Banihani, Lamiaa Elnahas, Graham R Plant, Anthony S Ward, Magdy R MoawadAbstract:Infected Popliteal Aneurysm is a rare high-risk condition that can present as an emergency with acute rupture and sepsis. Management of acute ischemia in the presence of local and systemic sepsis is challenging. Open surgery is not always possible and carries a high risk of morbidity and death. An endovascular approach has been advocated in infected Aneurysms elsewhere in the body, with good short-term and medium-term outcomes encouraging such approach in the Popliteal Artery. We report a case of successful endovascular treatment of an infected ruptured Popliteal Aneurysm with favorable outcome after 2-year follow-up and a related review of the literature.
M Lepantalo - One of the best experts on this subject based on the ideXlab platform.
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successful percutaneous endovascular treatment of a ruptured Popliteal Artery Aneurysm
Journal of Vascular Surgery, 2000Co-Authors: Leo Ihlberg, Wolf D Roth, Anders N Alback, I Kantonen, M LepantaloAbstract:Abstract A rupture of the Popliteal Artery is a rare but dangerous complication of Aneurysmal disease. It accounts for 4% of all Popliteal Artery Aneurysms encountered and threatens the loss of the extremity and, infrequently, is also life-threatening. 1 when this clinical entity is confronted, a prompt operative intervention is indispensable for increasing the chances of limb salvage. We report the first, to our knowledge, successful endovascular treatment of a ruptured Popliteal Artery Aneurysm with a new polytetrafluoroethylene stent-graft in a patient who was unfit for a conventional surgical approach because of his severe pulmonary disease. (J Vasc Surg 2000;31:794-7.)