Infra-Inguinal Aneurysms – Threat to Life and Limb?

Objectives: To assess the outcomes of infra-inguinal aneurysms admitted to a regional vascular unit.Methods: All patients admitted with a primary diagnosis of infra inguinal aneurysms were identified from clinical coding lists over a four-year period (January 2008-May 2012).All patients were identified through clinical coding and records were checked to confirm diagnosis, management and outcome, with data analysed using SPSS v18.Results: 39 patients (mean age 58.3yr, range 18-98), of which 27 were male, were identified (24 PseudoAneurysms (PA), 12 True Aneurysms (TA) and 3 Mycotic Aneurysms (MA)).The majority of the PAs were secondary to Intravenous Drug Abuse, IVDA (41%), followed by interventional procedures (29%), vascular anastomotic sites (13%), orthopaedic surgery (13%) and penetrating trauma (4%).11/12 (92%) TAs were popliteal in origin, with 22/24 (92%) of PAs located at or around the femoral bifurcation.22/24 of PA (12 surgical; 4 endovascular stenting; 1 ultrasound guided thrombin injection; 4 ultrasound guided compression; 1 embolisation), 8/12 of TA (7 surgical; 1 endovascular stenting) and 3/3 MA (2 surgical; 1 combined surgical + endovascular stenting) required intervention.One patient underwent primary major amputation (popliteal TA) with a further three patients requiring major amputation post intervention (1 MA post bypass procedure, 1 PA post vessel ligation, 1 PA secondary to percutaneous intervention presenting with distal embolization requiring vessel ligation).Overall 30day mortality was 5.1% (n=2).Conclusions: Our results suggest that the risk of major amputation and mortality secondary to infra-inguinal aneurysms as a pathology is significant. Methods and MethodsA comprehensive, retrospective data collection was performed, identifying all infra-inguinal aneurysms admitted between January 2008 and May 2012.Data were extracted through clinical coding lists cross referenced with radiology department diagnosis list and subsequent case note review, resulting in 39 patients diagnosed with infra-inguinal aneurysms being identified.Data collected included: patient characteristics (admission date, age, gender, presentation); pathological characteristics (type of aneurysms, location, infective status, presentation signs and symptoms as well as size, laterality and concomitant aneurysms); intervention details (type of intervention, details of surgery, complications and outcome) and amputation rate and 30-day mortality (including peri-operative and in hospital mortality). Statistical analysisData were processed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Inc., Chicago, IL, USA, 2007).Qualitative variables were summarised by frequency and percentage, while non-normally distributed quantitative variables were described by the median and range. ResultsA total of 39 patients diagnosed and admitted to the vascular surgical unit with infra-inguinal aneurysms between January 2008 and May 2012, were identified, with a mean age of 56 years (range 18-98), of which 27 were males.