Surgical management of isolated superficial femoral artery degenerative aneurysms

• Published in: Journal of vascular surgery 2014, Vol.59 (1), p.152-158
• Main Authors: Perini, Paolo, MD, Jean-Baptiste, Elixene, MD, PhD, Vezzosi, Massimo, MD, Raynier, Jean-Luc, MD, Mottini, Francesca, MD, Batt, Michel, MD, Hassen-Khodja, Réda, MD, Salcuni, Pierfranco, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amputation; Aneurysm - diagnosis; Aneurysm - mortality; Aneurysm - physiopathology; Aneurysm - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Disease-Free Survival; Female; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Femoral Artery - surgery; France; Humans; Italy; Kaplan-Meier Estimate; Ligation; Limb Salvage; Logistic Models; Male; Multivariate Analysis; Retrospective Studies; Risk Factors; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Vascular Patency
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.07.011

Objective To investigate the mode of presentation, diagnosis, association with other aneurysms, operative management, and outcomes of superficial femoral artery (SFA) aneurysms. Methods Records of all patients who underwent surgery for isolated, true SFA aneurysms (not due to infection, vasculitis, or tissue disorders) from 2002 to 2012 in two European centers were retrospectively analyzed. Demographic (sex, age), clinical (cardiovascular risk factors, location of the aneurysm, symptoms, presentation, emergency setting), surgical and radiological data (diameter, surgical technique, runoff vessels patency, presence of aneurysms elsewhere) were obtained for analysis. Follow-up was undertaken with clinical and ultrasound examinations at 1 month, 3 months, 6 months, 12 months, and yearly thereafter. The patency of the graft and the status of the anastomoses and inflow and outflow vessels were assessed. Main end points were represented by 30 days and long-term mortality and amputation-free survival. Results A total of 27 cases of SFA aneurysm were analyzed. Mean age at operation was 78 years ± 8.5. At presentation, SFA aneurysms were often symptomatic (rupture was present in 7/27 cases and acute distal ischemia in 6/27 cases), large (mean diameter, 54 mm ± 33.1 mm), bilateral (38% of the cases), and associated with aneurysms elsewhere (84%). Sixteen patients underwent resection of the aneurysm and polytetrafluoroethylene interposition graft, seven patients exclusion of the aneurysm with a femoropopliteal bypass (autogenous bypass in five cases, prosthetic in two), three patients simple ligation, and one patient underwent primary amputation. Mean follow-up was 41.47 months (range, 0.43-128.67 months). Early (