Acute leg ischaemia from thrombosed popliteal artery aneurysms: role of preoperative thrombolysis.
OBJECTIVE
to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms.


METHODS
retrospective study; teaching hospital.


METHODS
between 1990 and 2000, 109 popliteal artery aneurysms were operated on. In 24 patients acute leg ischaemia due to thrombosis of aneurysm was present.


METHODS
ten patients underwent urgent surgical intervention (group 1); and 14 thrombolysis with urokinase, until patency of popliteal and tibial vessels was achieved or for a maximum of 3 days (group 2). Ultrasonographic follow-up was performed at 1, 3, 6 and 12 months and then annually. Early results and follow-up data were analysed by chi-square test and life-table analysis (Kaplan-Meier curve) and late results were compared by mean of log rank test.


RESULTS
in group 1 early limb salvage was 70%; in group 2 it was 86% (p=n.s.). When thrombolysis was successful, patency and limb salvage were 100%. There was no local or systemic complications during thrombolysis nor worsening of ischaemia. Follow-up was completed in 91 cases, with a mean duration of 26 months. Forty-eight months primary patency rate was better, even if not statistically significant, in group 2 than in group 1.


CONCLUSIONS
in patients with acute leg ischaemia due to thrombosis of popliteal artery aneurysms, preoperative thrombolysis can be considered a safe and effective alternative to urgent surgery.
Dorigo
W
W
Department of Vascular Surgery, University of Florence, Florence, Italy.
Pulli
R
R
Turini
F
F
Pratesi
G
G
Credi
G
G
Innocenti
A Alessi
AA
Pratesi
C
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator