Moussa O*, Mittapalli D and Suttie SA
Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
Received: 05 December, 2015; Accepted: 05 January, 2016;Published: 08 January, 2016
Osama M Moussa, Department of Vascular Surgery, Ninewells Hospital and Medical School. Dundee, DD1 9SY, UK, Tel: 01382 660111; E-mail:
Moussa O, Mittapalli D, Suttie SA (2016) Infra-Inguinal Aneurysms – Threat to Life and Limb? Int J Vasc Surg Med. 2: 001-005. DOI: 10.17352/2455-5452.000008
© 2016 Moussa O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Peripheral; Aneurysms; Pseudoaneurysms; Management; Surgical; Radiological
Objectives: To assess the outcomes of infra-inguinal aneurysms admitted to a regional vascular unit.
Methods: All patients admitted with a primary diagnosis of infra inguinal aneurysms were identified from clinical coding lists over a four-year period (January 2008–May 2012). All patients were identified through clinical coding and records were checked to confirm diagnosis, management and outcome, with data analysed using SPSS v18.
Results: 39 patients (mean age 58.3yr, range 18-98), of which 27 were male, were identified (24 PseudoAneurysms (PA), 12 True Aneurysms (TA) and 3 Mycotic Aneurysms (MA)). The majority of the PAs were secondary to Intravenous Drug Abuse, IVDA (41%), followed by interventional procedures (29%), vascular anastomotic sites (13%), orthopaedic surgery (13%) and penetrating trauma (4%). 11/12 (92%) TAs were popliteal in origin, with 22/24 (92%) of PAs located at or around the femoral bifurcation. 22/24 of PA (12 surgical; 4 endovascular stenting; 1 ultrasound guided thrombin injection; 4 ultrasound guided compression; 1 embolisation), 8/12 of TA (7 surgical; 1 endovascular stenting) and 3/3 MA (2 surgical; 1 combined surgical + endovascular stenting) required intervention. One patient underwent primary major amputation (popliteal TA) with a further three patients requiring major amputation post intervention (1 MA post bypass procedure, 1 PA post vessel ligation, 1 PA secondary to percutaneous intervention presenting with distal embolization requiring vessel ligation). Overall 30-day mortality was 5.1% (n=2).
Conclusions: Our results suggest that the risk of major amputation and mortality secondary to infra-inguinal aneurysms as a pathology is significant.
An increase in life expectancy, intravenous drug abuse and the number of vascular surgical interventions all have led to a parallel increase in the incidence of infra-inguinal aneurysms. Infra inguinal aneurysms can be life and limb threatening due to their potential to cause embolism, thrombosis, and compression of surrounding structures and depending on aetiology, rupture. True infra-inguinal arterial aneurysms (TA) are most commonly seen in the popliteal arteries, whereas pseudoaneurysms (PA) are seen mostly in the femoral artery . The majority of true popliteal aneurysms remain asymptomatic with reported complication rates of 8% to 39% over 3 - 8 years follow up respectively [2,3]. Femoral pseudoaneurysms on the other hand are usually symptomatic with a reported complication rate of up to 47% . Rupture is relatively uncommon for non-infected femoral PAs, with a reported incidence of 1 – 12% [5,6], but is potentially catastrophic . Femoral PAs may present with acute thrombosis associated with substantial risk of limb loss (up to 28%) if collateral circulation is poor . Hence, timely diagnosis and management before complications ensue is paramount.
Not only do infra-inguinal aneurysms pose a threat to limb, there is also an association between femoral, popliteal and aortic aneurysms, with the incidence of aorto-iliac aneurysms in those with popliteal and femoral aneurysms up to 62% and 85% respectively [6,8].
We describe our experience with infra-inguinal aneurysms admitted to a tertiary vascular department covering a catchment area of 800,000 inhabitants.
Methods and Methods
A comprehensive, retrospective data collection was performed, identifying all infra-inguinal aneurysms admitted between January 2008 and May 2012. Data were extracted through clinical coding lists cross referenced with radiology department diagnosis list and subsequent case note review, resulting in 39 patients diagnosed with infra-inguinal aneurysms being identified. Data collected included: patient characteristics (admission date, age, gender, presentation); pathological characteristics (type of aneurysms, location, infective status, presentation signs and symptoms as well as size, laterality and concomitant aneurysms); intervention details (type of intervention, details of surgery, complications and outcome) and amputation rate and 30-day mortality (including peri-operative and in hospital mortality).
Data were processed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Inc., Chicago, IL, USA, 2007). Qualitative variables were summarised by frequency and percentage, while non-normally distributed quantitative variables were described by the median and range.
A total of 39 patients diagnosed and admitted to the vascular surgical unit with infra-inguinal aneurysms between January 2008 and May 2012, were identified, with a mean age of 56 years (range 18-98), of which 27 were males.
PAs accounted for 24/39 (median age 49 years, range 18-85), TAs 12/39 (median age 76 years, range 65-98) and MAs for 3/39 (median age 55 years, range 51-69), Table 1, Figure 1 depicts the management pathways and outcomes.
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