Clinical Outcome of Acute Leg Ischaemia Due to Thrombosed Popliteal Artery Aneurysm: Systematic Review of 895 Cases

Abstract

Objectives: A systematic review was performed to summarise outcomes of acute thrombosed popliteal artery aneurysms (PAAs) treated with thrombolysis or thrombectomy followed by bypass. Methods: A systematic review was conducted of data on acute thrombosed PAAs dated 1 January 1990 through 30 June 2008 using the Cochrane Library, MEDLINE and EMBASE databases. Primary endpoint was limb salvage; secondary endpoints were mortality and patency of the bypasses. Results: Eight prospective studies and 25 retrospective studies with 895 patients presenting with acute ischaemia were included. No randomised trials were included. The mortality rate after surgical repair was 3.2% (95% confidence interval (C.I.) 1.8–4.6). The amputation rate was 14.1% (95% C.I. 11.8–16.4). Thrombolysis before surgery did not result in a significant reduction of the number of amputations, compared with surgery (thrombectomy and bypass) alone. The mean primary patency rates of the bypasses at 1, 3 and 5 years were 79%, 77% and 74%, respectively, in the ‘thrombolysis’ group and 71% (P = 0.026), 54% (P = 0.164) and 45% (P = 0.249) in the ‘thrombectomy’ group. No distinction could be made regarding secondary patency and limb-salvage rates between the groups owing to insufficient data. Conclusions: Preoperative and intra-operative thrombolyses result in a significant improvement in 1-year primary graft patency rates, but do not result in a significant reduction for amputations compared with surgery alone.