OUTCOME ANALYSIS OF POPLITEAL ARTERY ANEURYSM REPAIR

OBJECTIVES: This study aimed to better analyze outcomes of surgical therapy for popliteal artery aneurysms (PAA).

METHODS: This is a retrospective analysis of prospectively collected data regarding operations performed for PAA obtained from the National Surgical Quality Improvement Program of 123 Veterans Affairs Medical Centers. Bivariate analysis and stepwise multivariate logistic regression were used to characterize risk factors associated with 30-day morbidity and mortality.

RESULTS: Of 583 operations for PAA in 537 patients during 1994-2005, almost all were in men (99.8%) and mean age was 67.9 years. Death occurred in 8 patients (1.4%). Serious complications occurred in 11.8%, of which 6.3% required arterial-specific reoperations. Emergency surgery was associated with increased complication rate [odds ratio (OR) 2.5 (95% confidence interval 1.4-4.4), p=0.001] and mortality [OR 5.9 (1.4-25.4), p=0.02]. Independent predictors for serious complications and death in the multivariate model were preoperative dependent functional status [adjusted OR 2.1 (1.0-4.3), p=0.05] and intraoperative red blood cell transfusion [adjusted OR 4.6 (2.3-9.2), p<0.0001]. Functional status was categorized by grading a patient’s ability to perform predefined activities of daily living without assistance of nursing care, equipment, or devices before surgery. The requirement of even one unit of blood intraoperatively was associated with a much higher risk of complications [OR 4.3 (2.5-7.3), p <0.0001] and death [OR 14.6 (3.4-62.5), p=0.001]. Crude survival was 92.6% at 1 year and 86.1% at 2 years. Ninety-nine percent, 97.6%, and 96.2% of survivors remained amputation-free at 30 days, 1 year, and 2 years, respectively.

CONCLUSIONS: Surgery for PAA offers excellent 2-year limb salvage in carefully selected patients; electively treating those with independent preoperative functional status and paying particular attention to minimizing operative blood loss optimizes the chances for good outcomes.