Vascular morbidity and mortality during long-term follow-up in claudicants selected for peripheral bypass surgery.

OBJECTIVES: To identify claudicants at high risk (and low risk) of late vascular morbidity and mortality after peripheral bypass surgery. DESIGN: Prospective cohort study with mean follow-up of 8.6 years. PATIENTS: One-hundred and fifty-five claudicants selected for peripheral bypass surgery. Only three patients were lost to follow-up. End points were major vascular events, additional interventions, all-cause mortality, and functional outcome. RESULTS: Major vascular events occurred in 59 patients. Life-table analysis revealed an annual risk increase of 3.5%. Strong predictors were hypertension (hazard ratio (HR) 2.7; 95% confidence interval (CI) 1.5-4.8), diabetes (HR 2.4; 95% CI 1.0-5.4) and cardiac disease (HR 2.2; 95% CI 1.2-4.0). Sixty patients needed additional interventions with a highest incidence (17%) in the first year, and thereafter 2.8% each year. None of the known risk factors were associated with an altered incidence of interventions. Approximately 3.5% of patients died per year compared with 2% per year in the control group. Prominent high-risk factors for mortality were cardiac disease (HR 3.3; 95% CI 1.8-6.0) and diabetes (HR 3.0; 95% CI 1.5-7.1). CONCLUSION: Major vascular events and additional interventions are common and serious in claudicants. However, it is possible to select low-risk patients in which peripheral bypass surgery is justified.

Ruptured popliteal artery aneurysm. An insidious complication.

OBJECTIVES: To evaluate the incidence and clinical presentation of ruptured popliteal aneurysms. METHODS: The records of 89 consecutive patients, all males, seen between 1958 and 1995 with 124 arteriosclerotic popliteal aneurysms were reviewed retrospectively. Most aneurysms were symptomatic (69/124; 55.6%). In six cases (6/124; 4.8%) a rupture was present. RESULTS: There was a wide range in primary diagnosis varying from deep venous thrombosis to peroneal nerve palsy. In all cases primary reconstructive surgery was performed. No primary or secondary amputations were necessary. Surgical outcome was good in four cases. In the remaining cases one patient suffered from a permanent peroneal nerve palsy and one from non-disabling claudication. Review of the literature showed a rupture incidence of 2.5% (range 0-16%) and amputation rates as high as 100%. CONCLUSION: An acute rupture of a popliteal aneurysm is rare. Although the clinical presentation can be non-specific, this possibility must be especially taken into account when dealing with older male patients presenting with signs and symptoms of generalised atherosclerosis and non-specific pain in the popliteal region.

Atherosclerotic popliteal aneurysm.

BACKGROUND: A popliteal artery aneurysm (PAA) has been described as a 'sinister harbinger of sudden catastrophe'. This review seeks to provide data regarding the epidemiological aspects, natural history, clinical presentation and results of treatment to help clinicians make appropriate decisions. METHODS: A systematic review of data in the English language literature published since 1980. RESULTS: The authors include 29 studies containing 1673 patients with 2445 PAAs. No controlled trials exist regarding the management of PAAs. CONCLUSION: (1) At most, only four or five patients are seen each year by a major vascular centre; (2) aortic aneurysms are found in 37 per cent and bilateral PAAs in 50 per cent of patients; (3) more than 95 per cent of patients are men with a mean age of 65 years and 45 per cent have hypertension; (4) approximately one-third of patients are asymptomatic at the time of initial diagnosis; (5) the risk of ischaemic complications after conservative follow-up varies from 8 to 100 per cent (mean 36 per cent), depending on the selection of patients and duration of follow-up; (6) elective surgical reconstruction is recommended for all asymptomatic aneurysms; (7) 5-year graft patency rates after surgical repair range from 29 to 100 per cent, with 5-year limb salvage ranging from 75 to 98 per cent; (8) patient survival rates at 5 and 10 years are 70 and 44 per cent respectively; (9) lifelong, careful patient surveillance is essential to detect and treat new aneurysms at other sites.