RESUMO
OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.
Assuntos
Aneurisma/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Artéria Poplítea/patologia , Trombose/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , Idoso , Amputação Cirúrgica/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/epidemiologia , Aneurisma/patologia , Austrália/epidemiologia , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Europa (Continente)/epidemiologia , Feminino , Carga Global da Doença , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/estatística & dados numéricos , Grau de Desobstrução VascularRESUMO
INTRODUCTION: The popliteal artery aneurysm (AAP) is localized and irreversible walls of the popliteal artery dilation. It is rare pathology is the second most common location of true aneurysms after aortic, and the first location within the peripheral aneurysms. It is characterized by affecting mainly men at an average age of 65, whose manifestations are mainly ischemic, finishing lower limb amputation in a frequency ranging as appropriate between 7 and 20 percent. Our goal is to make the presentation of a case of AAP with subacute arterial ischemia, along with a literature review of the topic. CASE PRESENTATION: the case of a 63 year old who consulted for lower limb pain 96 hours of evolution, with absence of pulses is presented a diagnosis of advanced subacute ischemia was performed resvascularizable not in the context of a clinically unstable patient. emergency amputation is decided. In dissecting the presence of PSA objective. DISCUSSION: The AAP have an incidence of 0.1 to 1%, have variable clinical. Arteriography is the gold standard for diagnosis. The treatment of choice is surgical, presenting new therapeutic options. The anatomical variations of the branches of the PA are variable to consider. Aneurysms are most commonly associated with contralateral popliteal (57.1%). CONCLUSIONS: We conclude that our conduct was appropriate considering the state of the patient.
INTRODUCCIÓN: El aneurisma de la arteria poplítea (AAP) es la dilatación localizada e irreversible de las paredes de la Arteria Poplítea. Es patología poco frecuente, constituye la segunda ubicación más frecuente de aneurismas verdaderos luego de los aórticos, y la primera ubicación dentro de los aneurismas periféricos. Se caracteriza por afectar a principalmente a hombres a una edad promedio de 65 años, cuyas manifestaciones son principalmente de origen isquémico, acabando en amputación del miembro inferior en una frecuencia que oscila según los casos entre un 7 y un 20 por ciento. Nuestro objetivo es realizar la presentación de un caso de AAP con isquemia arterial subaguda, junto con una actualización bibliográfica del tema. PRESENTACION DE CASO: Se presenta el caso de un paciente de 63 años de edad quien consultó por dolor de miembro inferior 96 horas de evolución, con ausencia de pulsos. Se realizó el diagnóstico de isquemia subaguda evolucionada, no resvascularizable en el contexto de un paciente clínicamente inestable. Se decide amputación de urgencia. En la disección se objetiva la presencia de un AAP CONCLUSIONES: Concluimos que nuestra conducta fue adecuada considerando el estado del paciente. DISCUCIÓN: : Los AAP tienen una incidencia de entre el 0,1 al 1%, presentan clínica variable. La arteriografía es gold standard para su diagnóstico. El tratamiento de elección es quirúrgico, presentándose nuevas opciones terapéuticas. Las variaciones anatómicas de las ramas de la AP son una variable a considerar. Los aneurismas asociados con mayor frecuencia son los poplíteos contralaterales (57,1%).
Assuntos
Aneurisma/patologia , Aneurisma/cirurgia , Artéria Poplítea/patologia , Artéria Poplítea/cirurgia , Amputação Cirúrgica , Aneurisma/diagnóstico por imagem , Humanos , Isquemia , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Resultado do TratamentoRESUMO
Las lesiones vasculares en cirugía artroscópica corresponden a menos del 1% de todas las complicaciones. En la reconstrucción del ligamento cruzado posterior, dada la relación anatómica existente entre el mismo y las estructuras neurovasculares de la región poplítea, el riesgo de lesión de la arteria poplítea es alto, aunque infrecuente según lo informado en la literatura médica. Dado la baja incidencia de esta complicación, pero su potencial gravedad, presentamos un caso de un pseudoanerurisma de la arteria poplítea luego de la reconstrucción artroscópica del ligamento cruzado posterior. Tipo de estudio: Reporte de caso. Nivel de evidencia: IV.
Vascular lesions in arthroscopic surgery correspond to less than 1% of all complications. In the reconstruction of the posterior cruciate ligament, given the anatomical relationship between it and the neurovascular structures of the popliteal region, the risk of injury to the popliteal artery is high but infrequent as reported in the medical literature. Given the low incidence of this complication, but its potential severity, we present a case of a pseudoanerurysm of the popliteal artery after the arthroscopic reconstruction of the posterior cruciate ligament. Type of study: Case report. Level of evidence: IV.
Assuntos
Adulto Jovem , Falso Aneurisma/diagnóstico , Traumatismos do Joelho/complicações , Artéria Poplítea/patologia , Reconstrução do Ligamento Cruzado Posterior/efeitos adversos , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Resultado do TratamentoRESUMO
Aim: To present a true aneurysm in childhood, an uncommon pathology, even more those who affect the popliteal artery. case report: We present the case of a boy 3 years old with a true aneurysm with popliteal location. conclusion: Because of its possible complications, the treatment is surgery.
Objetivo: Presentar un caso de aneurisma verdadero en niños, patología poco frecuente, más aún aquellos que afectan a la arteria poplítea. caso clínico: Se presenta el caso de un niño de 3 años con un aneurisma verdadero de localización poplítea. conclusión: Debido a sus posibles complicaciones, el tratamiento es quirúrgico.
Assuntos
Humanos , Masculino , Pré-Escolar , Artéria Poplítea/cirurgia , Artéria Poplítea/patologia , Aneurisma/cirurgia , Aneurisma/patologia , Veia Safena/transplanteRESUMO
La enfermedad Adventicia Quística (EAQ), compromete principalmente la arteria poplítea, presentando síntomas de claudicación intermitente en pacientes jóvenes, sin factores de riesgo para patología arterial periférica. Presentamos un caso en un paciente de 40 años con (EAQ) en el que se describe su tratamiento, siendo la resección quirúrgica, con abordaje posterior lo indicado en estos pacientes...
The Cystic Adventitial Disease (CAD) mainly involves the popliteal artery, presenting intermittent claudication in young patients, with no risk factors for peripheral artery pathology. One case of a 40-year-old patient with CAD is presented in this paper in which his treatment is described. Surgical resection whit posterior approach is wath is indicated in these patients...
Assuntos
Adulto , Artéria Poplítea/cirurgia , Artéria Poplítea/patologia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/patologia , Articulação do Joelho/cirurgia , Claudicação Intermitente/etiologiaRESUMO
Cystic degeneration of the popliteal artery is an uncommon cause of intermittent claudication. We report a 52 years old male consulting for intermittent claudication referred to the calf. The angiography showed a 93% stenosis in segment of 45 mm length of the left popliteal artery with a smooth surface, suggesting an extrinsic compression. A CT angiography of the lower limb suggested the presence of a cystic degeneration. The patient was operated and the middle third of the popliteal artery was excised. The pathological study of the surgical piece was informed as artery media cystic degeneration.
Assuntos
Claudicação Intermitente/patologia , Doenças Vasculares Periféricas/patologia , Artéria Poplítea/patologia , Humanos , Claudicação Intermitente/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea/cirurgiaRESUMO
Arterial compression syndromes can be identified in asymptomatic individuals using specific diagnostic maneuvers involving palpation of peripheral pulses. OBJECTIVE: To identify diagnostic maneuvers positive for extrinsic compression in the upper and lower limbs of people who exercise regularly. METHODS: The sample consisted of people over 18 years old who had been attending a gym for a minimum of 1 hour per week and for at least 1 month. A data collection instrument comprising 20 questions was administered to the study participants, covering personal characteristics, the types of exercises engaged in and possible symptoms. The Adson, Hyperabduction and Costoclavicular maneuvers and also tests to reveal popliteal artery entrapment were performed. Data from the questionnaires and the maneuver results were analyzed using SPSS v.20.0. RESULTS: The study enrolled 202 volunteers who attended the gyms investigated, comprising 98 women and 104 men aged 18 to 63 (mean of 27 years). One hundred and seventy (84.2%) subjects were asymptomatic and 32 (15.8%) people reported some type of discomfort such as pain, paresthesia or a cool sensation. Ninety of the 202 individuals analyzed (44.6%) exhibited at least one positive maneuver. Total numbers of compressions per subject were as follows: two people (1%) had four positive maneuvers; 19 (9.4%) had three positive maneuvers; 31 (15.3%) had two positive maneuvers, 38 (18.8%) exhibited one positive maneuver and 112 (55 4%) people were positive for none of the maneuvers. The hyperabduction maneuver was the most prevalent maneuver. CONCLUSION: Diagnostic maneuvers positive for extrinsic arterial compression were identified in 44.6% of the asymptomatic individuals analyzed...
As síndromes compressivas arteriais podem ser identificadas em indivíduos assintomáticos por manobras semiológicas específicas, com a palpação dos pulsos periféricos. OBJETIVO: Identificar manobras semiológicas positivas para compressão extrínseca em membros superiores e inferiores em indivíduos que realizam regularmente musculação. MÉTODOS: a amostra consistiu de pessoas maiores de 18 anos que frequentaram, por pelo menos um mês, no mínimo uma hora por semana, a academia. Os participantes da pesquisa preencheram um questionário de 20 questões que abordava características pessoais, exercícios praticados e eventuais sintomas. Foram realizadas as manobras de Adson, Hiperabdução, Costoclavicular e para aprisionamento da artéria poplítea. Os resultados dos questionários e das manobras realizadas foram avaliados com o programa computacional SPSS v.20.0. RESULTADOS: foram incluídos no estudo 202 voluntários que frequentaram as academias escolhidas, sendo 98 mulheres e 104 homens, com idade entre 18 e 63 anos (média de 27 anos). Cento e setenta (84,2%) indivíduos eram assintomáticos e 32 (15,8%) referiram algum tipo de desconforto, como dor, sensação de esfriamento ou parestesia. Dos 202 indivíduos avaliados, 90 (44,6%) apresentaram alguma das manobras positivas. Com relação ao número de compressões, dois indivíduos (1%) apresentaram quatro manobras positivas; 19 (9,4%), três manobras; 31(15,3%), duas manobras; 38 (18,8%), uma manobra, e 112 (55,4%), nenhuma. A manobra de hiperabdução foi a mais prevalente dentre as manobras realizadas. CONCLUSÃO: foram identificadas manobras semiológicas positivas para compressão extrínseca arterial em 44,6% dos indivíduos assintomáticos avaliados...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Idoso , Artéria Poplítea/patologia , Síndrome do Desfiladeiro Torácico/diagnóstico , Tamponamento Cardíaco/complicações , Estudos Transversais/métodos , Extremidade Inferior , Extremidade SuperiorRESUMO
A claudicação intermitente está frequentemente associada à doença aterosclerótica, mas diagnósticos diferenciais devem ser pesquisados em pacientes sem fatores de risco tradicionais. A doença cística adventicial, de etiologia incerta, acomete em maior proporção a artéria poplítea e, eventualmente, apresenta-se como claudicação intermitente. Apresentamos um caso da doença e seu manejo cirúrgico, e discutimos a etiopatogenia, os aspectos diagnósticos e terapêuticos da enfermidade.
Intermittent claudication is frequently associated with atherosclerotic disease, but differential diagnosis must be sought in patients with no traditional risk factors. Cystic adventitial disease, of unknown etiology, most frequently affects the popliteal artery, and occasionally presents as intermittent claudication. We report a case of this disease and the surgical treatment, and discuss some aspects related to etiopathogenesis, diagnosis and treatment of this condition.