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Intraluminal thrombus volume correlates with the crural vessel runoff in popliteal artery aneurysms upon initial
Hans-Christian Arne Stroth1, Floris Berg1, Hannah Emilia Freytag2
1Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Germany.
Insights
Intraluminal thrombus volume in popliteal artery aneurysms (PAA) significantly correlates with reduced crural runoff. Higher thrombus load indicates poorer outcomes, especially in emergency cases.
Area of Science:
- Vascular Surgery
- Aneurysm Research
- Medical Imaging Analysis
Background:
- Emergency surgery for popliteal artery aneurysms (PAA) leads to worse patient outcomes compared to elective procedures.
- Limited crural vessel runoff is a primary factor contributing to poorer outcomes in emergency PAA cases.
- Understanding PAA morphology's impact on crural runoff is crucial for predicting surgical success.
Purpose of the Study:
- To investigate the relationship between PAA diameter, volume, and intraluminal thrombus load.
- To determine the correlation of these PAA characteristics with preoperative crural vessel runoff.
- To identify prognostic indicators for outcomes in patients with PAAs.
Main Methods:
- Retrospective analysis of surgically treated PAA patients.
- Semi-automated quantitative CT analysis of PAA diameter, volume, and intraluminal thrombus volume.
- Correlation analysis between PAA morphology parameters and the number of patent crural vessels.
Main Results:
- Intraluminal thrombus (ILT) volume showed the strongest correlation with reduced crural runoff (r=-0.34, p=0.01).
- No significant correlation was found between PAA diameter and crural runoff (r=-0.17, p=0.1).
- Reduced crural runoff was significantly associated with impaired amputation-free survival (p=0.01).
- Thrombus volume index was higher in emergency PAA cases.
Conclusions:
- Intraluminal thrombus volume is a key predictor of reduced crural runoff in PAAs.
- ILT volume should be considered a prognostically important factor, especially with rapid PAA growth.
- CT-based assessment of ILT load can aid in risk stratification for PAA patients.
Abstract:
Background: Patients having emergency surgery due to ischemia caused by a popliteal artery aneurysm (PAA) have worse outcomes in all endpoints (operation time, major adverse limb events (MALE), amputation-free survival) than after elective treatment, mostly due to a limited crural vessel runoff. This study investigates the relationship between PAA diameter, volume, and luminal thrombus load in relation to the preoperative crural runoff. Patients and methods: Retrospective single-centre evaluation of surgically treated patients with PAA and semi-automated quantitative CT analysis of PAA morphologies (diameter, volume and intraluminal thrombus volume). Primary endpoints were the correlations these characteristics with the number of patent crural vessels. Results: A total of 89 PAAs (61 patients, median age 75, IQR 12; 94.4% male) were identified, of which 47.2% were symptomatic with 18 acute limb ischemia (ALI). The diameter at surgery was 33.8 ± 12.1mm and the volume 68.5 ± 13.6mm3. A median of two lower leg vessels were patent (elective 3 [1, 2, 3] vs. emergency 1 [1, 2], p=0.1) upon preoperative CTA. 77 PAAs underwent elective surgery, five PAAs (5.6%) received endovascular treatment. The surgical complication rate was 23.6% without immediate or early occlusion. The follow-up was 42.5 [39-45] months. The overall mortality rate was 11.2% and the primary patency rate 73.9%. While the total aneurysm volume correlated well with the diameter (r=0.77, p<0.01), the intraluminal thrombus volume (ILT) showed the clearest correlation with the crural runoff (r=-0.34, p=0.01). No correlation between the diameter and crural runoff was observed (r=-0.17, p=0.1). A reduced crural run-off was significantly associated with impaired amputation-free survival (p=0.01). A subgroup analysis (n=21) with sequential CTs showed a tendency towards greater increase of thrombus volume compared to plain diameter during PAA growth. The thrombus volume index (=ILT/total PAA volume) was significantly higher in emergency patients (p=0.01), while diameters tended to be smaller (p=0.57). Conclusions: The increasing intraluminal thrombus volume correlates most distinctly with a reduced crural runoff in PAAs and should therefore be considered prognostically important, especially in the presence of an increased growth rate compared to the diameter.
