Aneurismas poplíteos. Evolución y factores pronósticos en la trombosis del saco

Resumen

Objetivos

Conocer la evolución de aneurismas poplíteos tratados quirúrgicamente y evaluar factores pronósticos en la trombosis del saco.

Pacientes y métodos

Desde mayo de 1993 hasta junio del año 2005, 43 pacientes presentaron 64 aneurismas poplíteos (diámetro medio: 2,8 cm; intervalo: 1,2-8 cm); de ellos, 19 (29%) han recibido tratamiento médico (compensación tras trombosis), dos (3%) aneurismectomía más injerto terminoterminal vía posterior, 22 (34%) exclusión por ligadura más bypass poplíteo-poplíteo y, por último, 21 (32%) exclusión y bypass femoropoplíteo. Hemos realizado un estudio descriptivo transversal en los 43 aneurismas tratados mediante exclusión y bypass (67%). Mediante eco-Doppler de control se evaluó: diámetro, presencia de flujo o trombosis del aneurisma y permeabilidad del bypass. Se analizó, mediante regresión de Cox, si existía asociación estadísticamente significativa entre la trombosis postoperatoria del saco aneurismático y los siguientes factores: diámetro preoperatorio del aneurisma, edad, factores de riesgo cardiovascular, comorbilidad, tipo de tratamiento,

run-off

permeabilidad del bypass y presencia de aneurisma contralateral o de aorta.

Resultados

De 43 aneurismas intervenidos, se pudieron evaluar 25 (56%). Se detectó flujo Doppler intraaneurismático en cuatro casos (16%); de éstos, hubo crecimiento del saco en tres (12%), y en uno (4%) disminuyó. De los 21 casos (84%) con trombosis completa del saco, se detectó su crecimiento en dos (8%), y en los 19 restantes (76%) disminuyó. El control clínico medio fue de 65 meses (intervalo: 1-128 meses). No se detectaron roturas ni síntomas compresivos. El tipo de cirugía resultó ser el único factor estadísticamente significativo (p = 0,04).

Conclusiones

La reparación quirúrgica no garantiza la trombosis del aneurisma. El bypass poplíteo-poplíteo muestra mayores garantías en la trombosis del saco aneurismático.

Summary

Aims

To determine how surgically treated popliteal aneurysms progressed and to evaluate the prognostic factors for thrombosis of the aneurysmal sac.

Patients and methods

Between May 1993 and June 2005, 43 patients presented with 64 popliteal aneurysms (mean diameter: 2.8 cm; interval: 1.2-8 cm), of which 19 (29%) received medical treatment (compensation following thrombosis), two (3%) underwent an aneurysmectomy plus an end-to-end graft inserted using a posterior approach, 22 (34%) were treated with exclusion by ligation plus popliteal-popliteal bypass and, lastly, 21 (32%) underwent exclusion and femoral-popliteal bypass. We conducted a cross-sectional descriptive study in the 43 aneurysms treated by means of exclusion and bypass (67%). A control Doppler ultrasound recording was used to evaluate diameter, presence of flow or thrombosis of the aneurysm and patency of the bypass. Cox regression was used to analyse whether there was a statistically significant association between post-operative thrombosis of the aneurysmal sac and the following factors: pre-operative diameter of the aneurysm, age, cardiovascular risk factors, comorbidity, type of treatment, run-off, patency of the bypass and the presence of a contralateral or aortic aneurysm.

Results

Of the 43 aneurysms that were treated with surgery, we were able to evaluate 25 (56%). Intra-aneurysmal Doppler flow was detected in four cases (16%); of these, the sac was seen to have grown in three (12%) and it had diminished in one (4%). Of the 21 cases (84%) with complete thrombosis of the sac, growth was detected in two of them (8%) and it had diminished in the remaining 19 (76%). Mean clinical monitoring time was 65 months (interval: 1-128 months). No ruptures or symptoms of compression were detected. Findings showed that type of surgery is the only statistically significant factor (p = 0.04).

Conclusions

Surgical repair does not guarantee thrombosis of the aneurysm. A popliteal-popliteal bypass offers a higher degree of safety in thrombosis of the aneurysmal sac.