腘动脉瘤的临床特征、治疗策略及远期疗效的单中心26例回顾性分析

Clinical characteristics, treatment strategies, and long-term outcomes of popliteal artery aneurysms: a single-center retrospective study of 26 patients

摘要:

背景与目的 腘动脉瘤（PAA）是最常见的外周动脉瘤，可因血栓形成或远端栓塞导致急性肢体缺血，严重时危及患肢存活。目前国内关于PAA临床特点及治疗结局的单中心研究仍较少。本研究回顾性分析PAA患者的临床资料，总结其临床特征、治疗策略及远期疗效。方法 回顾性分析2018年1月—2024年12月中南大学湘雅二医院血管外科收治并接受手术治疗的PAA患者资料。收集患者基线特征、手术方式、围手术期并发症及随访资料。采用Kaplan-Meier法评估术后保肢率、一期通畅率及二期通畅率，并比较大隐静脉移植与人工血管移植患者的一期通畅率。结果 共纳入26例患者，治疗30条患肢，其中男性18例（69.2%），平均年龄（59.2±14.2）岁。6例（23.1%）为双侧病变，6例（23.1%）合并主动脉或髂动脉瘤。真性动脉瘤24条（80.0%），假性动脉瘤6条（20.0%）。开放手术28条（93.3%），腔内修复2条（6.7%）。开放手术包括瘤体切除联合人工血管移植16条（53.3%）、大隐静脉移植6条（20.0%）、端端吻合5条（16.7%）及动脉修补1条（3.3%）。术后30 d并发症发生率为10.0%，无围手术期死亡。中位随访时间60.0（19.5~81.3）个月。术后6个月、1年及3年保肢率均为100.0%，5年保肢率为93.8%；一期通畅率分别为92.8%、92.8%、92.8%和86.7%；二期通畅率分别为96.2%、96.2%、96.2%和89.3%。大隐静脉移植组6年一期通畅率为100.0%，人工血管移植组为53.1%，差异无统计学意义（P=0.208）。结论 PAA患者具有较高的双侧病变及主动脉相关动脉瘤共患率，诊疗过程中应重视全身动脉系统筛查。开放手术安全有效，自体大隐静脉在条件允许时应作为优选移植物。腔内修复可作为特定患者的替代方案，但其长期疗效仍需进一步验证。

Abstract:

Background and Aims Popliteal artery aneurysm (PAA) is the most common peripheral arterial aneurysm and may result in acute limb ischemia due to thrombosis or distal embolization. Evidence regarding the clinical characteristics and long-term outcomes of PAA in Chinese populations remains limited. This study aimed to evaluate the clinical features, treatment strategies, and long-term outcomes of surgically treated PAA patients at a single center.Methods Patients with PAA who underwent surgical treatment at the Department of Vascular Surgery, the Second Xiangya Hospital of Central South University between January 2018 and December 2024 were retrospectively reviewed. Baseline characteristics, operative details, perioperative outcomes, and follow-up data were collected. Limb salvage, primary patency, and secondary patency were estimated using Kaplan-Meier analysis. Primary patency was further compared between great saphenous vein grafts and prosthetic grafts.Results A total of 26 patients involving 30 limbs were included. The cohort comprised 18 men (69.2%) with a mean age of (59.2±14.2) years. Bilateral lesions were identified in 6 patients (23.1%), and concomitant aortic or iliac aneurysms were present in 6 patients (23.1%). Twenty-four limbs (80.0%) had true aneurysms, and six (20.0%) had pseudoaneurysms. Open surgical repair was performed in 28 limbs (93.3%), whereas endovascular repair was performed in 2 limbs (6.7%). Open procedures included prosthetic graft reconstruction in 16 limbs (53.3%), great saphenous vein grafting in 6 (20.0%), end-to-end anastomosis in 5 (16.7%), and arterial repair in 1 (3.3%). The 30-day complication rate was 10.0%, and no perioperative deaths occurred. The median follow-up duration was 60.0 (19.5-81.3) months. Limb salvage rates were 100.0% at 6 months, 1 year, and 3 years, and 93.8% at 5 years. Primary patency rates were 92.8%, 92.8%, 92.8%, and 86.7%, while secondary patency rates were 96.2%, 96.2%, 96.2%, and 89.3%, respectively. The 6-year primary patency rate was 100.0% in the great saphenous vein group and 53.1% in the prosthetic graft group, without a statistically significant difference (P=0.208).Conclusion Patients with PAA demonstrate a substantial prevalence of bilateral disease and concomitant aortic aneurysmal disease, highlighting the importance of comprehensive vascular screening. Open repair remains safe and effective, and autologous great saphenous vein grafts should be preferred whenever feasible. Endovascular repair may serve as an alternative option in selected patients, although further studies are required to clarify its long-term durability.