Popliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. Few data are available in the literature about the treatment results in these scenarios. The aim of the present study was to evaluate an 11-year multicenter experience in the urgent treatment of PAAs. All symptomatic PAAs surgically treated in two vascular centers between 2010 and 2021 were retrospectively analyzed. In the postoperative period periodical clinical and Duplex-Ultrasound evaluation were performed. The evaluated endpoint was the outcome of urgent PAAs treatment according to their clinical presentation. Statistical analysis was performed by Kaplan-Meier log-rank evaluation and multivariable Cox regression tests. Sixty-six PAAs needed an urgent repair. Twelve (18%) patients had a PAA rupture and 54 (82%) had an acute limb ischemia (ALI) due to either distal embolization or acute thrombosis. Patients with ALI underwent bypass surgery in 51 (95%) cases, which was associated with preoperative thrombolysis in 18 (31%) cases. A primary major amputation was performed in 3 (5%) cases. The mean follow-up was 52 ± 21 months with an overall 5-year limb salvage of 83 ± 6%. Limb salvage was influenced only by the number of patent tibial arteries (pTA) [5-years limb salvage 0%, 86 ± 10%, 92 ± 8% and 100% in case of 0, 1, 2 or 3 pTA, respectively (P = .001)]. An independent association of number of pTA and limb loss was found [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03–0.6), P = .001]. Overall 5-year survival was 71 ± 7%. Ruptured PAAs were associated with lower 5-year survival compared with the ALI group (48 ± 2% vs. 79 ± 7%, P = .001). The number of pTA (33 ± 20%, 65 ± 10%, 84 ± 10% and 80 ± 10% for 0, 1, 2 and 3 pTA, respectively, P = .001) and the thrombolysis (94 ± 6% vs. 62 ± 10%, P = .03) were associated with higher survival in patients with ALI. There was an independent association of number of pTA and long-term survival [HR 0.15 (95% CI 0.03–0.8), P = .03]. PAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and it is associated with lower long-term survival. ALI can benefit from thrombolysis, and long-term limb salvage and survival are associated with the number of pTA.

中文翻译：

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腘动脉瘤紧急手术治疗后的保肢和生存

腘动脉瘤（PAA）在发生急性血栓形成、远端栓塞或破裂时需要紧急治疗。文献中很少有关于这些情况下治疗结果的数据。本研究的目的是评估 11 年多中心紧急治疗 PAA 的经验。回顾性分析了 2010 年至 2021 年间在两个血管中心接受手术治疗的所有症状性 PAA。在术后期间进行定期临床和多普勒超声评估。评估的终点是根据临床表现进行紧急 PAAs 治疗的结果。通过 Kaplan-Meier 对数秩评估和多变量 Cox 回归检验进行统计分析。66 个 PAA 需要紧急维修。12 名患者 (18%) 发生 PAA 破裂，54 名患者 (82%) 因远端栓塞或急性血栓形成而发生急性肢体缺血 (ALI)。ALI 患者中有 51 例（95%）接受了搭桥手术，其中 18 例（31%）与术前溶栓有关。3 例 (5%) 病例进行了初次大截肢。平均随访时间为 52 ± 21 个月，总体 5 年保肢率为 83 ± 6%。保肢仅受未闭胫骨动脉 (pTA) 数量的影响 [在 0、1、2 或 3 个 pTA 的情况下，5 年保肢分别为 0%、86 ± 10%、92 ± 8% 和 100%（ P = .001)]。发现 pTA 数量与肢体丧失之间存在独立关联[风险比 (HR)：0.14（95% 置信区间 (CI) 0.03–0.6），P = .001]。总体 5 年生存率为 71 ± 7%。与 ALI 组相比，PAA 破裂与较低的 5 年生存率相关（48 ± 2% vs. 79 ± 7%，P = .001）。pTA 数量（0、1、2 和 3 个 pTA 分别为 33 ± 20%、65 ± 10%、84 ± 10% 和 80 ± 10%，P = .001）和溶栓（94 ± 6% vs . 62 ± 10%, P = .03) 与 ALI 患者的较高生存率相关。pTA 数量与长期生存存在独立关联 [HR 0.15 (95% CI 0.03–0.8)，P = .03]。PAA 破裂是近五分之一病例需要紧急 PAA 治疗的原因，并且与较低的长期生存率相关。ALI可受益于溶栓治疗，长期保肢和生存与pTA的数量相关。