RESUMO
OBJECTIVES: To evaluate the outcome of acute popliteal artery aneurysm (PAA) thrombosis and leg ischemia after preoperative or intraoperative use of intra-arterial urokinase thrombolysis. MATERIALS AND METHODS: From 2000 to 2009, 86 patients with acute leg ischemia (Rutherford grade IB to IIA) from PAA thrombosis were treated by immediate surgery including intraoperative thrombolysis (group A: 47 cases) or preoperative thrombolysis (group B: 39 cases) followed by acute (<24 hours) or elective surgery. Chi-square tests for categorical data and time to event provided two-sided p values with a level of significance at 0.05 and all confidence intervals (CIs) at the 95% level. RESULTS: The mean follow-up was 45 months. The 2-year primary patency was 61.7% (29/47) for group A and 43.6% (17/39) for group B (hazard ratio [HR] 1.85; 95% CI: 0.96 to 3.54; p = 0.06). The 2-year secondary patency was 70.2% (33/47) for group A and 53% (21/39) for group B (HR 1.86; 95% CI: 0.91 to 3.81; p = 0.08). One-month amputation rate was 18% in group A and 29% in group B (p < 0.001), and 12-month amputation rate was 19% (9/47) in group A and 44% (17/39) in B (p = 0.05). In group A, 28% of patients required fasciotomy and in group B, 59% (p < 0.05). Effective thrombolysis allowed 82% limb salvage patency in group B. No systemic or locoregional complications during thrombolysis were recorded, but four cases of worsening ischemia were recorded. CONCLUSION: Our results suggest that the immediate surgery with intraoperative thrombolysis improved the outcome of patients with acute leg ischemia due to PAA thrombosis in terms of limb salvage.
Assuntos
Aneurisma/terapia , Implante de Prótese Vascular , Fibrinolíticos/administração & dosagem , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea , Terapia Trombolítica/métodos , Trombose/terapia , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Idoso , Amputação Cirúrgica , Aneurisma/diagnóstico , Aneurisma/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Distribuição de Qui-Quadrado , Terapia Combinada , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Cuidados Intraoperatórios , Isquemia/diagnóstico , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/fisiopatologia , Cuidados Pré-Operatórios , Reoperação , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Trombose/diagnóstico , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Grau de Desobstrução VascularRESUMO
Popliteal venous aneurysms (PVA) are rare and in most cases the first sign of their presence is a pulmonary embolus or other thromboembolic events. We report four cases of PVA, in two of these the first sign of their presence was an acute pulmonary embolism; in two remaining cases the diagnosis was fortuitous. Accurate evaluation of venous system of lower limb by duplex scan is important in all cases of pulmonary embolism, the anticoagulation may be ineffective in preventing pulmonary embolism and the surgical repair is the mainstay of therapy of this pathology because it is safe and effective.
