Outcomes of surgical management for popliteal artery aneurysms: An analysis of 583 cases

Document Type

Journal Article

Publication Date

10-1-2008

Journal

Journal of Vascular Surgery

Volume

48

Issue

4

DOI

10.1016/j.jvs.2008.05.063

Abstract

Background: This study aimed to analyze outcomes of surgical management for popliteal artery aneurysms (PAA). Methods: This is a retrospective analysis of prospectively collected data regarding operations for PAA obtained from 123 United States Veterans Affairs Medical Centers as part of the National Surgical Quality Improvement Program. Univariate analyses and multivariate logistic regression were used to characterize 33 risk factors and their associations with 30-day morbidity and mortality. Survival and amputation rates, observed at one and two years after surgery, were subject to life-table and Cox regression analyses. Results: There were 583 operations for PAA in 537 patients during 1994-2005. Almost all were in men (99.8%) and median age was 69 years (range, 34 to 92 years). Most had multiple co-morbidities, 88% were ASA (American Society of Anesthesiologists) class 3 or 4, and 81% were current or past smokers (median pack-years = 50). Only 16% were diabetic. Serious complications occurred in 69 (11.8%) cases, of which 37 (6.3%) required arterial-specific reinterventions. Eight patients died within 30 days, a mortality of 1.4%. Risk factors associated with increased complications included: African-American race (odds ratio [OR] 2.8 [95% confidence interval 1.5-5.2], P = .002), emergency surgery (OR 3.8 [2.0-7.0], P < .0001), ASA 4 (OR 1.9 [1.1-3.5], P = .04), dependent functional status (OR 2.5 [1.4-4.7], P = .004), steroid use (OR 3.2 [1.2-8.7], P = .03), and need for intraoperative red blood cell transfusion of any quantity (OR 6.3 [3.5-11.2], P < .0001). Independent predictors for complications in the multivariate model were dependent functional status (adjusted OR 2.1 [1.1-4.3], P = .049) and intraoperative transfusion (adjusted OR 4.5 [2.3-8.9], P = .0002). Postoperative bleeding complications within 72 hours independently predicted early amputation (adjusted OR 25.5 [1.7-393], P = .02). Unadjusted patient survival was 92.6% at one year and 86.1% at two years. Limb salvage in surviving patients was 99.0% at 30 days, 97.6% at one year, and 96.2% at two years. Dependent preoperative functional status was the only factor predictive of worse two-year limb salvage (adjusted OR 4.6 [1.9-10.9], P = .001), but remained high at 88.2% versus 97.1% in independent patients. Conclusions: Surgical intervention for PAA is associated with low operative mortality and offers excellent two-year limb salvage, even in high-risk patients. Patients' preoperative functional status and perioperative blood transfusion requirements were the most predictive indicators of negative outcomes. © 2008 The Society for Vascular Surgery.

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