Acute leg ischaemia from thrombosed popliteal artery aneurysms: Role of preoperative thrombolysis

Abstract

Objective: to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms. Setting: retrospective study; teaching hospital. Materials: 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. © 2002 Elsevier Science Ltd. All rights reserved.