Determining Patient Risk Factors Associated with Accelerated Growth of Popliteal Artery Aneurysms
Ryan S. Cousins, M.S., David J. Dexter, M.D., Sadaf Ahanchi, M.D., R.P.V.I, Gordon K. Stokes, M.D., F.A.C.S., Sarah B. Ongstad, M.D., Brandon C. Cain, M.D., Obie M. Powell, M.D., Niraj M. Parikh, M.B.B.S., Jean M. Panneton, M.D., F.R.C.S.C., F.A.C.S..
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES: To determine the natural progression of popliteal artery aneurysms (PAA) and clinical variables that are associated with accelerated growth
METHODS: Retrospective chart review of 224 patients with at least one PAA was conducted from January 2009-May 2016. From this group, 65 asymptomatic patients were found to have unilateral (N=43) or bilateral (N=22) PAAs that were followed for at least one year of medical management prior to intervention. We divided these patients into two groups based upon whether their overall growth rate was above or below 1.22mm/yr. Aneurysm diameter was taken from duplex ultrasound and CT imaging.
RESULTS: 87 aneurysms were evaluated among 65 patients. Mean age at diagnosis was 70.9 [68.89, 72.89]. 64 were male (98%). 50 (77%) were Caucasian and 7 (11%) were African American. The average BMI was 27.69 [26.64, 28.73]. 61 (94%) patients had a concomitant aneurysm at or prior to the time of diagnosis. 51 (78%) patients were current or former smokers. 16 (25%) had atrial fibrillation. The average growth rate of PAAs was 1.22 mm/yr [0.8.10, 1.63]. The mean surveillance follow-up time from initial diagnosis to last follow-up or to intervention was 3.12 years [2.77, 3.48]. Of 87 aneurysms, 22 (25%) went on to repair. 16 (72%) were repaired due to size criteria, 3 (14%) due to acute limb ischemia with limb salvage, and 3 (14%) due to thrombus with claudication. 63 aneurysms (72%) did not require an intervention during our study window. The mean initial diameter at diagnosis was 16.9mm [15.8, 18.1]. 48 (55%) aneurysms developed thrombus within the PAA. The mean ABI at diagnosis was 1.0 [0.941, 1.053]. Univariate analysis identified initial diameter (14.7mm vs. 19.2mm, p=0.02), atrial fibrillation (16.0% vs. 53.8%, p=0.042), and the presence of thrombus (33.3% vs. 66.7%, p=<0.001) as predictors of diameter expansion greater than the mean. Multivariate analysis of the univariate factors determined that only initial diameter (p=0.007, OR: 5.53) and the presence or development of thrombus (p=0.08, OR: 4.00) maintained significance.
CONCLUSIONS: Patients presenting with a popliteal artery aneurysm at or greater than 20mm in diameter, presence of thrombus, or atrial fibrillation may need to be observed using more frequent scanning intervals than those without these risk factors. Further studies are required to validate these predictive PAA growth factors.
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