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Arteriosclerosis in popliteal artery trifurcation as a predictor for myocardial infarction after arterial
Insights
Trifurcation of the popliteal artery disease (TFD) significantly increases the risk of myocardial infarction after lower limb vascular reconstruction. Identifying TFD preoperatively aids in patient selection and monitoring for cardiovascular events.
Area of Science:
- Vascular Surgery
- Cardiology
- Atherosclerosis Research
Background:
- Lower limb vascular reconstruction is a common procedure for patients with peripheral artery disease.
- Myocardial infarction (MI) is a significant cause of perioperative morbidity and mortality in these patients.
- The role of atherosclerotic lesions in the popliteal artery trifurcation in predicting postoperative MI is not well-established.
Purpose of the Study:
- To investigate the relationship between the extent of atherosclerotic lesions in the popliteal artery trifurcation and the incidence of postoperative myocardial infarction.
- To determine the impact of trifurcation disease (TFD) on 30-day mortality after lower limb vascular reconstruction.
- To identify preoperative indicators for patients at higher risk of MI following vascular surgery.
Main Methods:
- Retrospective analysis of 158 patients undergoing aortoiliac reconstruction and 239 patients undergoing femorodistal bypass.
- Assessment of atherosclerotic lesions in the trifurcation of the popliteal artery.
- Correlation of TFD presence with postoperative MI and 30-day mortality.
Main Results:
- No postoperative MI occurred in patients without TFD.
- MI developed in 4/50 patients with TFD in the aortoiliac group (p<0.05).
- MI developed in 18/174 patients with TFD in the femorodistal group (p<0.05); MI was the cause of death in 9 instances.
Conclusions:
- The presence of TFD is a strong predictor of postoperative myocardial infarction after lower limb vascular reconstruction.
- A potential correlation exists between TFD and coronary artery disease, contributing to increased MI risk.
- Preoperative identification of TFD can guide treatment selection, patient monitoring, and surgical indications to mitigate cardiovascular complications.
Abstract:
The frequency of myocardial infarction and mortality within 30 days after lower limb vascular reconstruction, in relation to the extent of atherosclerotic lesions in the trifurcation of the popliteal artery, have been retrospectively analyzed in 158 consecutive patients reconstructed in the aortoiliac region and 239 consecutive patients undergoing femorodistal bypass. Among the patients without trifurcational disease (TFD) none had myocardial infarction develop postoperatively, as compared with four of the 50 patients with TFD in the aortoiliac series (p less than 0.05) and 18 of the 174 patients with TFD in the femorodistal series (p less than 0.05). In nine instances, the cause of death was myocardial infarction. The strong correlation between postoperative myocardial infarction and the presence of TFD, may be due to a direct correlation between coronary artery disease and TFD. The finding is of practical importance in the selection of treatment for patients with circulatory disorders of the lower limbs. The finding facilitates the preoperative identification of patients liable to have myocardial infarction develop. Indications for operation can be made more stringent and optimal intraoperative and postoperative monitoring can be instituted.