User login
SAN FRANCISCO - Predictors of acute aneurysm - related complications were aneurysm size of 4 cm or greater, thrombus, and age younger than 60 years, in a study of patients with isolated degenerative femoral artery aneurysms.
"Acute complications have not occurred in patients with FAAs less than 3.5 cm, suggesting that this should be adopted as a new threshold for elective repair," Dr. Gustavo S. Oderich said at the Society for Vascular Surgery Annual Meeting.
Femoral artery aneurysms (FAAs) are rare, affecting 5/100,000 individuals, said Dr. Oderich, a vascular surgeon who practices at the Mayo Clinic, Rochester, Minn. Current indications for repair are symptoms, size greater than 2.5 cm, growth, and thrombus.
Most reports of FAAs predate modern imaging. These studies "are limited by the small number of patients, mixed etiology, and short follow-up," Dr. Oderich said. "The purpose of the current study was to review the clinical presentation, management strategies, and outcomes of degenerative FAAs in a larger cohort of patients."
For the study, led by Dr. Peter F. Lawrence of the University of California, Los Angeles, researchers retrospectively studied patients treated for degenerative FAAs between 2002 and 2012 at eight medical centers in the United States. Iatrogenic, anastomotic, and mycotic aneurysms were excluded from the analysis. Endpoints of interest were morbidity and mortality with operative repair; acute aneurysm - related complications including rupture, thrombosis, and embolization; and patient survival.
Dr. Oderich reported on 236 FAAs that occurred in 182 patients. The mean size was 32 cm. Most (81%) were located on the common femoral artery, 14% were located on the superficial femoral artery, and 5% were located on the profunda femoris artery. The majority of patients (88%) had synchronous aneurysms in other locations. The most common locations outside of the femoral artery were the aortic (62%) artery, common iliac arteries (60%), popliteal arteries (47%), and bilateral FAAs (25%).
The mean age of patients was 73 and 94% of patients were male. At presentation 63% of patients were asymptomatic. The most common signs and symptoms were palpable mass (29%), claudication (22%), and local pain (10%).
When the researchers compared symptomatic versus asymptomatic aneurysms, symptomatic aneurysms were larger, had more intraluminal thrombus, and more often affected the profunda femoral artery .Only 12 patients (5%) had acute events, most of them rupture or thrombosis, with a size of 3.5-7 cm in range.
Independent predictors associated with acute aneurysm - related complications were a diameter of 4 cm or greater (P = less than .001), an intraluminal thrombus (P = less than .001), and age younger than 60 (P = .004). Freedom from repair among patients with asymptomatic FAAs was 21% at 5 years, "largely reflecting our practice of indicating the operation for aneurysms greater than 2.5 cm," Dr. Oderich said. The most common indications for repair were pain (34%), intramural thrombus (27%), and size of 2.5 cm or greater (23%).
He reported that 138 patients underwent open repair and 3 patients underwent endovascular treatment of 177 FAAs. The most frequent form of reconstruction was an interposition graft (80%) or bypass (20%). Among the 141 patients who had operative treatment, the 30-day mortality was 1.5%, the morbidity rate was 20%, and the mean length of stay was 7 days. During a mean follow-up of 49 months, there were 35 nonaneurysm-related deaths (27%) and 1 graft-related complication. Patient survival at 5 years was 61%.
"Repair of smaller FAAs may be indicated in patients with intramural thrombus or progressive enlargement," Dr. Oderich concluded. "Current repair of all symptomatic FAAs should remain unchanged. Operative repair was associated with low mortality, morbidity, and durable results."
Decision making when faced with a patient with a degenerative femoral artery aneurysm has always been based on small series. Especially when deciding what size asymptomatic aneurysm is too big to continue to watch, the available data are weak.
The authors pooled a large number of cases from eight institutions to assemble a dataset of 236 FAAs, 25% of which were apparently observed without repair. (Disclaimer: One of my partners contributed data to this series.) They noted that no asymptomatic aneurysm less than 3.5 cm developed an acute complication, and concluded that the threshold for repair of these lesions should rise to at least 3.5 cm in diameter.
Although this report is retrospective and almost certainly contains selection bias, this conclusion seems valid to me at a gut level. I also agree that any symptoms or the presence of significant mural thrombus should prompt repair. Until we are able to capitalize on the capacity of electronic medical records to determine the clinical outcome of patients on the basis of diagnosis rather than what surgical procedure they have had, this is probably the best data we are likely to see regarding the management of FAA.
Dr. Larry W. Kraiss is professor and chief of vascular surgery at the University of Utah, Salt Lake City, and is an associate medical editor of Vascular Specialist.
Decision making when faced with a patient with a degenerative femoral artery aneurysm has always been based on small series. Especially when deciding what size asymptomatic aneurysm is too big to continue to watch, the available data are weak.
The authors pooled a large number of cases from eight institutions to assemble a dataset of 236 FAAs, 25% of which were apparently observed without repair. (Disclaimer: One of my partners contributed data to this series.) They noted that no asymptomatic aneurysm less than 3.5 cm developed an acute complication, and concluded that the threshold for repair of these lesions should rise to at least 3.5 cm in diameter.
Although this report is retrospective and almost certainly contains selection bias, this conclusion seems valid to me at a gut level. I also agree that any symptoms or the presence of significant mural thrombus should prompt repair. Until we are able to capitalize on the capacity of electronic medical records to determine the clinical outcome of patients on the basis of diagnosis rather than what surgical procedure they have had, this is probably the best data we are likely to see regarding the management of FAA.
Dr. Larry W. Kraiss is professor and chief of vascular surgery at the University of Utah, Salt Lake City, and is an associate medical editor of Vascular Specialist.
Decision making when faced with a patient with a degenerative femoral artery aneurysm has always been based on small series. Especially when deciding what size asymptomatic aneurysm is too big to continue to watch, the available data are weak.
The authors pooled a large number of cases from eight institutions to assemble a dataset of 236 FAAs, 25% of which were apparently observed without repair. (Disclaimer: One of my partners contributed data to this series.) They noted that no asymptomatic aneurysm less than 3.5 cm developed an acute complication, and concluded that the threshold for repair of these lesions should rise to at least 3.5 cm in diameter.
Although this report is retrospective and almost certainly contains selection bias, this conclusion seems valid to me at a gut level. I also agree that any symptoms or the presence of significant mural thrombus should prompt repair. Until we are able to capitalize on the capacity of electronic medical records to determine the clinical outcome of patients on the basis of diagnosis rather than what surgical procedure they have had, this is probably the best data we are likely to see regarding the management of FAA.
Dr. Larry W. Kraiss is professor and chief of vascular surgery at the University of Utah, Salt Lake City, and is an associate medical editor of Vascular Specialist.
SAN FRANCISCO - Predictors of acute aneurysm - related complications were aneurysm size of 4 cm or greater, thrombus, and age younger than 60 years, in a study of patients with isolated degenerative femoral artery aneurysms.
"Acute complications have not occurred in patients with FAAs less than 3.5 cm, suggesting that this should be adopted as a new threshold for elective repair," Dr. Gustavo S. Oderich said at the Society for Vascular Surgery Annual Meeting.
Femoral artery aneurysms (FAAs) are rare, affecting 5/100,000 individuals, said Dr. Oderich, a vascular surgeon who practices at the Mayo Clinic, Rochester, Minn. Current indications for repair are symptoms, size greater than 2.5 cm, growth, and thrombus.
Most reports of FAAs predate modern imaging. These studies "are limited by the small number of patients, mixed etiology, and short follow-up," Dr. Oderich said. "The purpose of the current study was to review the clinical presentation, management strategies, and outcomes of degenerative FAAs in a larger cohort of patients."
For the study, led by Dr. Peter F. Lawrence of the University of California, Los Angeles, researchers retrospectively studied patients treated for degenerative FAAs between 2002 and 2012 at eight medical centers in the United States. Iatrogenic, anastomotic, and mycotic aneurysms were excluded from the analysis. Endpoints of interest were morbidity and mortality with operative repair; acute aneurysm - related complications including rupture, thrombosis, and embolization; and patient survival.
Dr. Oderich reported on 236 FAAs that occurred in 182 patients. The mean size was 32 cm. Most (81%) were located on the common femoral artery, 14% were located on the superficial femoral artery, and 5% were located on the profunda femoris artery. The majority of patients (88%) had synchronous aneurysms in other locations. The most common locations outside of the femoral artery were the aortic (62%) artery, common iliac arteries (60%), popliteal arteries (47%), and bilateral FAAs (25%).
The mean age of patients was 73 and 94% of patients were male. At presentation 63% of patients were asymptomatic. The most common signs and symptoms were palpable mass (29%), claudication (22%), and local pain (10%).
When the researchers compared symptomatic versus asymptomatic aneurysms, symptomatic aneurysms were larger, had more intraluminal thrombus, and more often affected the profunda femoral artery .Only 12 patients (5%) had acute events, most of them rupture or thrombosis, with a size of 3.5-7 cm in range.
Independent predictors associated with acute aneurysm - related complications were a diameter of 4 cm or greater (P = less than .001), an intraluminal thrombus (P = less than .001), and age younger than 60 (P = .004). Freedom from repair among patients with asymptomatic FAAs was 21% at 5 years, "largely reflecting our practice of indicating the operation for aneurysms greater than 2.5 cm," Dr. Oderich said. The most common indications for repair were pain (34%), intramural thrombus (27%), and size of 2.5 cm or greater (23%).
He reported that 138 patients underwent open repair and 3 patients underwent endovascular treatment of 177 FAAs. The most frequent form of reconstruction was an interposition graft (80%) or bypass (20%). Among the 141 patients who had operative treatment, the 30-day mortality was 1.5%, the morbidity rate was 20%, and the mean length of stay was 7 days. During a mean follow-up of 49 months, there were 35 nonaneurysm-related deaths (27%) and 1 graft-related complication. Patient survival at 5 years was 61%.
"Repair of smaller FAAs may be indicated in patients with intramural thrombus or progressive enlargement," Dr. Oderich concluded. "Current repair of all symptomatic FAAs should remain unchanged. Operative repair was associated with low mortality, morbidity, and durable results."
SAN FRANCISCO - Predictors of acute aneurysm - related complications were aneurysm size of 4 cm or greater, thrombus, and age younger than 60 years, in a study of patients with isolated degenerative femoral artery aneurysms.
"Acute complications have not occurred in patients with FAAs less than 3.5 cm, suggesting that this should be adopted as a new threshold for elective repair," Dr. Gustavo S. Oderich said at the Society for Vascular Surgery Annual Meeting.
Femoral artery aneurysms (FAAs) are rare, affecting 5/100,000 individuals, said Dr. Oderich, a vascular surgeon who practices at the Mayo Clinic, Rochester, Minn. Current indications for repair are symptoms, size greater than 2.5 cm, growth, and thrombus.
Most reports of FAAs predate modern imaging. These studies "are limited by the small number of patients, mixed etiology, and short follow-up," Dr. Oderich said. "The purpose of the current study was to review the clinical presentation, management strategies, and outcomes of degenerative FAAs in a larger cohort of patients."
For the study, led by Dr. Peter F. Lawrence of the University of California, Los Angeles, researchers retrospectively studied patients treated for degenerative FAAs between 2002 and 2012 at eight medical centers in the United States. Iatrogenic, anastomotic, and mycotic aneurysms were excluded from the analysis. Endpoints of interest were morbidity and mortality with operative repair; acute aneurysm - related complications including rupture, thrombosis, and embolization; and patient survival.
Dr. Oderich reported on 236 FAAs that occurred in 182 patients. The mean size was 32 cm. Most (81%) were located on the common femoral artery, 14% were located on the superficial femoral artery, and 5% were located on the profunda femoris artery. The majority of patients (88%) had synchronous aneurysms in other locations. The most common locations outside of the femoral artery were the aortic (62%) artery, common iliac arteries (60%), popliteal arteries (47%), and bilateral FAAs (25%).
The mean age of patients was 73 and 94% of patients were male. At presentation 63% of patients were asymptomatic. The most common signs and symptoms were palpable mass (29%), claudication (22%), and local pain (10%).
When the researchers compared symptomatic versus asymptomatic aneurysms, symptomatic aneurysms were larger, had more intraluminal thrombus, and more often affected the profunda femoral artery .Only 12 patients (5%) had acute events, most of them rupture or thrombosis, with a size of 3.5-7 cm in range.
Independent predictors associated with acute aneurysm - related complications were a diameter of 4 cm or greater (P = less than .001), an intraluminal thrombus (P = less than .001), and age younger than 60 (P = .004). Freedom from repair among patients with asymptomatic FAAs was 21% at 5 years, "largely reflecting our practice of indicating the operation for aneurysms greater than 2.5 cm," Dr. Oderich said. The most common indications for repair were pain (34%), intramural thrombus (27%), and size of 2.5 cm or greater (23%).
He reported that 138 patients underwent open repair and 3 patients underwent endovascular treatment of 177 FAAs. The most frequent form of reconstruction was an interposition graft (80%) or bypass (20%). Among the 141 patients who had operative treatment, the 30-day mortality was 1.5%, the morbidity rate was 20%, and the mean length of stay was 7 days. During a mean follow-up of 49 months, there were 35 nonaneurysm-related deaths (27%) and 1 graft-related complication. Patient survival at 5 years was 61%.
"Repair of smaller FAAs may be indicated in patients with intramural thrombus or progressive enlargement," Dr. Oderich concluded. "Current repair of all symptomatic FAAs should remain unchanged. Operative repair was associated with low mortality, morbidity, and durable results."
AT THE SVS ANNUAL MEETING
Major finding: Among patients treated for isolated degenerative femoral artery aneurysms, independent predictors associated with acute aneurysm–related complications were a diameter of 4 cm or greater (P = less than .001), an intraluminal thrombus (P = less than .001), and age younger than 60 (P = .004).
Data source: A retrospective study of 182 patients in the United States who were treated for 236 femoral artery aneurysms that occurred between 2002 and 2012.
Disclosures: Dr. Oderich disclosed that he has served as a consultant to W.L. Gore and Cook Medical.
