Small popliteal artery aneurysms: important clinical consequences and contralateral survey in daily vascular surgery practice.

OBJECTIVE: The management of small popliteal artery aneurysms remains a matter of debate. The goal of this study was to gain additional knowledge about this pathology, focusing specifically on popliteal arteries smaller than 20 mm in diameter. Furthermore, the need for surveillance of the contralateral popliteal artery in patients with a small aneurysm was studied. METHODS: A retrospective follow-up study was conducted in 2 Dutch hospitals. From 1998 until 2011, data were collected through a search in the hospital patient databases. A small aneurysm (which was defined as a popliteal artery diameter of 10-20 mm) was identified and evaluated in 73 patients. These patients were monitored, whereby symptoms, complications, and survival were recorded. In addition, the contralateral popliteal artery was analyzed in all 73 patients. RESULTS: Of 73 small aneurysms, 58% were asymptomatic, of which 24% developed an indication for surgical repair during follow-up. Furthermore, 32% were symptomatic and 11% completely thrombosed. Results of surgically treated aneurysms were good, with a secondary patency of 90% after a median follow-up of 30 months. A contralateral popliteal artery exceeding 10 mm was present in 49 patients (67%), of whom 59% had an indication for surgery. CONCLUSION: This study found that small popliteal artery aneurysms show a considerable risk of becoming symptomatic. In all patients with a known popliteal artery aneurysm, investigation of the contralateral popliteal artery is advised.

Long-term outcome of popliteal artery aneurysms after ligation and bypass.

OBJECTIVES: After exclusion of popliteal artery aneurysms (PAAs) through bypass surgery, there is a risk of persistent flow through collaterals and growth of the excluded aneurysmal sac. This study was conducted to evaluate this risk at long-term follow-up. METHODS: Sixty-five PAAs treated by proximal and distal ligation and bypass grafting with reversed autologous vein in 52 patients (1998-2010) were retrospectively reviewed. RESULTS: Mean follow-up was 41 months (range, 1-144 months). Five aneurysms showed residual flow (8%). One of these aneurysms had increased in size, 36 months postoperatively. This aneurysm underwent an embolization procedure after which no flow or further enlargement was demonstrated. CONCLUSION: In this study, the risk of persistent flow in a PAA excluded by proximal and distal ligation and bypass is low. Still, considering this risk and its possible complications, follow-up by duplex ultrasound in all patients until up to more than 10 years postoperatively is recommended.

Aprotinin does not diminish blood loss in elective operations for infrarenal abdominal aneurysms: a randomized double-blind controlled trial.

Surgery for abdominal aneurysm is associated with substantial blood loss. In cardiac surgery, aprotinin, a fibrinolysis inhibitor, has shown to reduce blood loss significantly. Our aim was to assess the effect of aprotinin, when administered during elective surgery of infrarenal abdominal aneurysm, on coagulation, blood loss, and morbidity. A double-blind randomized trial was performed on 35 consecutive patients. They were randomized to either an aprotinin or a placebo group. The aprotinin group received 2,000,000 kallikrein inhibiting units (KIU) of aprotinin (500,000 KIU in 50 mL NaCl 0.9%) as a starting dose, followed by 500,000 KIU per hour during the operation. The placebo group received equal amounts of only NaCl 0.9%. During the operation and 24 hr thereafter, blood samples were taken to assess coagulation factors. Blood loss was measured in suction devices and swabs. All patients were followed until their discharge from the hospital. Statistical analysis was performed by independent t-test or Mann-Whitney U-test and chi-squared test. There was no significant difference in the amount of blood loss or the amount of blood products administered between the two groups. Morbidity and mortality were also comparable. In both groups, consumption of clotting factors could be detected, indicating activation of the coagulation cascade. However, in the aprotinin group, the alpha2-antiplasmin level was raised during surgery, indicating inhibition of fibrinolysis. Administration of aprotinin during elective operations for infrarenal aortic aneurysm induces inhibition of fibrinolysis. However, it does not significantly reduce blood loss or the need for blood products.

Thoracic sympathectomy: effects on hemodynamics and baroreflex control.

UNLABELLED: Endoscopic thoracic sympathectomy at T2-T4 is an effective and safe treatment for primary axillary and palmar hyperhidrosis and facial blushing refractory to conventional treatment. T2 and T4 ganglia however are in the direct pathway of sympathetic innervation of the heart and part of the vasomotor nerves. In this study we investigate possible changes in steady-state hemodynamics as well as in beat-to-beat cardiovascular control after thoracoscopic sympathectomy of T2-T4. In 12 patients we measured continuously heart rate (HR) and blood pressure (BP) (non-invasively with Finapres) during rest and during deep inspiration, in supine and sitting position as well as during a change from lying to standing. Stroke volume (SV) and total peripheral resistance (TPR) were estimated from the BP recordings by the Modelflow method. Markers for cardiovascular control were obtained from power and cross-spectra of BP and HR. After sympathectomy, only in the sitting position was mean HR decreased, while TPR and BP (diastolic and mean) were lower in the supine as well as sitting positions. SV clearly increased. Low frequency power in HR and BP was significantly decreased, just like the max/min ratio in HR after standing up, indicating a diminished capacity in sympathetic vasomotor control. High frequency power of HR as well as baroreflex sensitivity, both parasympathetic markers, did not change in a statistically significant manner. CONCLUSION: Besides altering steady-state hemodynamics, a thoracic sympathectomy causes relatively small, though measurable changes in cardiovascular control, in particular of peripheral vasomotion.