Does infrapopliteal arterial runoff predict success for popliteal artery aneurysmorrhaphy?

Ryan T. Hagino, Roy M. Fujitani, David L Dawson, David L. Cull, Jeffrey L. Buehrer, Spence M. Taylor, Joseph L. Mills

Research output: Contribution to journalArticle

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Abstract

background: A 6-year experience with surgical management of popliteal artery aneurysms (PAAs) was examined to determine the influence of infrapopliteal outflow vessel patency on the long-term success of popliteal artery aneurysmorrhaphy. methods: Arteriograms were reviewed to characterize the anatomy of the infrapopliteal arterial runoff. Regular clinical evaluation and prospective serial duplex scan surveillance assessed graft patency. results: A total of 28 patients underwent 45 popliteal aneurysmorrhaphies. Elective repair was performed in 32 limbs (71%); emergency treatment was needed for 13 limbs (29%) because of acute limb-threatening ischemia. All patients were managed with PAA exclusion and reversed saphenous vein grafting. Only 20 limbs (44%) had a patent trifurcation with three continuous vessels to the ankle, 13 (29%) had two continuous tibial vessels, 10 (22%) had one patent runoff artery, and 2 (4%) had no vessel continuous to the foot. With a mean follow-up of 19.1 months, the 5-year primary graft patency by life-table analysis was 95 ± 12.3%, with a 5-year assisted primary patency of 97 ± 10.0%. One vein graft underwent elective secondary revision. Another graft thrombosed, requiring a secondary bypass. Outcome did not correlate with the status of the runoff anatomy. Limb salvage was 100%. conclusion: The use of autologous reversed vein grafting and attention to technical details yielded normal graft hemodynamics and excellent long-term patency and limb salvage despite the suboptimal runoff anatomy associated with PAAs.

Original languageEnglish (US)
Pages (from-to)652-658
Number of pages7
JournalThe American Journal of Surgery
Volume168
Issue number6
DOIs
StatePublished - 1994
Externally publishedYes

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Popliteal Artery
Transplants
Extremities
Aneurysm
Anatomy
Limb Salvage
Veins
Life Tables
Emergency Treatment
Saphenous Vein
Ankle
Foot
Thrombosis
Ischemia
Arteries
Hemodynamics

ASJC Scopus subject areas

  • Surgery

Cite this

Does infrapopliteal arterial runoff predict success for popliteal artery aneurysmorrhaphy? / Hagino, Ryan T.; Fujitani, Roy M.; Dawson, David L; Cull, David L.; Buehrer, Jeffrey L.; Taylor, Spence M.; Mills, Joseph L.

In: The American Journal of Surgery, Vol. 168, No. 6, 1994, p. 652-658.

Research output: Contribution to journalArticle

Hagino, Ryan T. ; Fujitani, Roy M. ; Dawson, David L ; Cull, David L. ; Buehrer, Jeffrey L. ; Taylor, Spence M. ; Mills, Joseph L. / Does infrapopliteal arterial runoff predict success for popliteal artery aneurysmorrhaphy?. In: The American Journal of Surgery. 1994 ; Vol. 168, No. 6. pp. 652-658.
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abstract = "background: A 6-year experience with surgical management of popliteal artery aneurysms (PAAs) was examined to determine the influence of infrapopliteal outflow vessel patency on the long-term success of popliteal artery aneurysmorrhaphy. methods: Arteriograms were reviewed to characterize the anatomy of the infrapopliteal arterial runoff. Regular clinical evaluation and prospective serial duplex scan surveillance assessed graft patency. results: A total of 28 patients underwent 45 popliteal aneurysmorrhaphies. Elective repair was performed in 32 limbs (71{\%}); emergency treatment was needed for 13 limbs (29{\%}) because of acute limb-threatening ischemia. All patients were managed with PAA exclusion and reversed saphenous vein grafting. Only 20 limbs (44{\%}) had a patent trifurcation with three continuous vessels to the ankle, 13 (29{\%}) had two continuous tibial vessels, 10 (22{\%}) had one patent runoff artery, and 2 (4{\%}) had no vessel continuous to the foot. With a mean follow-up of 19.1 months, the 5-year primary graft patency by life-table analysis was 95 ± 12.3{\%}, with a 5-year assisted primary patency of 97 ± 10.0{\%}. One vein graft underwent elective secondary revision. Another graft thrombosed, requiring a secondary bypass. Outcome did not correlate with the status of the runoff anatomy. Limb salvage was 100{\%}. conclusion: The use of autologous reversed vein grafting and attention to technical details yielded normal graft hemodynamics and excellent long-term patency and limb salvage despite the suboptimal runoff anatomy associated with PAAs.",
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