Aneurismas poplíteos rotos: revisión a 28 años / Popliteal aneurysm rupture: A 28-year review

RESUMEN

INTRODUCCIÓN: La rotura de un aneurisma poplíteo (AP) es una complicación insólita, que ocurre tan solo en un 0-7% en las series publicadas. OBJETIVOS: Describiremos los casos acontecidos durante 28 años en nuestro servicio características clínicas, resultados y peculiaridades de una entidad tan infrecuente en nuestra práctica clínica habitual. MATERIAL Y MÉTODOS: Entre agosto de1986 y enero de 2014, se intervinieron 157 AP en 132 pacientes, de los cuales 8 (5,1%) se presentaron clínicamente con rotura aneurismática 6 varones y 2 mujeres. Edad media 80,6 ± 6,2 años. ANTECEDENTES tabaco 4, HTA 8, EPOC 4, dislipidemia 2, cardiopatía 2; DM 1; isquemia cerebrovascular 1. Aneurismas en otras localizaciones bilateralidad 5; aortoilíaco 1. El 100% fueron sintomáticos con hematoma y edema de extremidad; isquemia aguda asociada 2 casos; isquemia crónica asociada 2. Método diagnóstico eco 6; eco + arteriografia 3; TAC 1. Tamaño > 3 cm, con trombo mural 100%. Forma fusiforme 2; sacular 6. Todos fueron cirugía urgente por abordaje medial. Técnica quirúrgica ligadura sin revascularización 2; ligadura + bypass PTFE 2; ligadura + bypass de vena safena interna 2; resección + PTFE 2. RESULTADOS: Permeabilidad 100%. Complicaciones postoperatorias un seroma, un absceso. Tasa de amputación 0%. Fallecimiento precoz 0%. Alta 6 casos asintomáticos; 2 con claudicación intermitente por arteriopatía distal previa. CONCLUSIÓN: La rotura de un AP sucede generalmente en varones añosos. Constituye una urgencia quirúrgica en la que es crucial un diagnóstico precoz y diferencial, ante la presencia de edema o hematoma con masa pulsátil en hueco poplíteo. La cirugía abierta sigue siendo el tratamiento de elección, reservándose la terapia endovascular para casos seleccionados

ABSTRACT

INTRODUCTION: Rupture of popliteal aneurysms (PA) is exceptional, only occurs in 0-7% in published series, and with few cases described in the literature. OBJECTIVES: A review of the cases recorded in a hospital unit over a 28-year period is presented, including their clinical features, the results, and other peculiarities obtained in such an uncommon occurrence in our daily clinical practice. MATERIAL AND METHODS: Between 1986 and 2014, there were 157 cases of AP involving 132 patients, of which 8 (5.1%), 6 males and 2 females, clinically presented with an aneurysm rupture. The mean age was 80.6 ± 6.2 years. Personal history Tobacco 4 patients, AHT 8, COPD 4, dyslipidemia 2, heart 2, DM 1, cerebrovascular ischemia 1. Aneurysms in other locations bilateral 5, and aorto-iliac 1. All symptomatic hematoma and/or limb edema, acute ischemia associated 2 cases, chronic ischemia associated 2 cases. The diagnostic method used was ECO 6, ECO + arteriography 3, and CT 1. Size > 3 cm with mural thrombus in 100% of cases. Form fusiform 2, saccular 6. All emergency surgery for medial approach. Surgical technique ligation without revascularization 2 + ligation PTFE bypass 2 + ligation bypass saphenous vein 2; resection + PTFE 2. RESULTS: Permeability 100%. Postoperative complications one seroma, one abscess. There was a 0% amputation rate. Early death 0%. There were 6 highly asymptomatic cases, and 2 with intermittent claudication due to previous distal artery disease. CONCLUSION: Rupture of an AP is an unusual event that usually occurs in very old males, and with large aneurysms. Saccular types seem to be associated with an increased in the risk of rupture. It is a surgical emergency, and although hemorrhagic shock is exceptional, early and differential diagnosis versus other pathologies is crucial when there is the presence of edema and/or hematoma in the limb with pulsatile mass in the popliteal fossa