Diameter Comparison of Saphenous Vein Bypasses for Popliteal Aneurysm Versus Peripheral Arterial Occlusive Disease in Matched Subjects

Abstract

Previous research has suggested that arterial aneurysm might result from a systemic tendency to dilatation. This systemic effect would involve both arterial and venous dilatation. The authors investigated whether venous grafts implanted to bypass popliteal artery aneurysms (PAA) had larger diameters than those implanted to treat peripheral arterial occlusive disease (PAOD). They compared representative diameters of 20 vein grafts implanted for PAA with matched bypass grafts implanted for PAOD. Graft diameters were obtained by means of CVI-Q M-mode ultrasound imaging. Each PAA patient/graft was matched to an equivalent PAOD patient/graft based on the patient's gender and age and the vein graft type and distal anastomosis. Secondarily, graft proximal anastomosis was matched in 60% (12/20) of the cases. Age was matched if the difference was <4 years. Average age at the time of surgery was 68 ±12 years for PAA and 68 ±13 for PAOD groups. There were 11 reversed greater saphenous vein (GSV), 2 nonreversed GSV, and 7 in situ GSV in each group. Distal anastomoses were at the popliteal (15), peroneal (3), posterior (1), and anterior tibial (1) arteries in each group. Matching was not possible for lesser saphenous and cephalic vein grafts or bypasses to the tibial-peroneal trunk. Graft diameters were significantly larger for the PAA group, 6.24 ± 0.66 mm (standard deviation), than for the PAOD group, 5.73 ± 0.69 mm (p < 0.02, Mann-Whitney U test). Of 10 bypasses with diameter > 6.5 mm, 8 were implanted for PAA. If these 10 largest bypasses were eliminated from the calculations, the mean graft diameters were 5.82 ± 0.51 mm and 5.57 ± 0.52 mm for the PAA and PAOD groups, respectively (p = 0.28). Bypass grafts implanted in PAA patients had significantly greater diameters than grafts implanted in PAOD patients. This finding, however, was due to a subgroup of grafts with diameters >6.5 mm. Perhaps systemic abnormalities associated with PAA should be first studied in patients with large vein grafts or large original veins.

Get full access to this article

View all access options for this article.

References

1. Flanigan DP : Aneurysms of the peripheral arteries. In: Vascular Surgery: A Comprehensive Review, ed. 5, ed. by Moore WS . Philadelphia: WB Saunders Co, 1998, pp 457-467.

2. Goldstone J : Aneurysms of the aorta and iliac arteries. In: Vascular Surgery: A Comprehensive Review, ed. 5, ed. by Moore WS . Philadelphia: WB Saunders Co, 1998, pp 435-457.

3. Cole CW , Thijssen AM , Barber GG , et al: Popliteal aneurysms: An index of generalized vascular disease. Can J Surg 32:65-68, 1989.

4. Powell JT , MacSweeney ST , Greenhalgh RM , et al: Interaction between fibrillin genotype and blood pressure and the development of aneurysmal disease. Ann NY Acad Sci 800:198-207, 1996.

5. Anderson DW , Edwards TK , Ricketts MH , et al: Multiple defects in type III collagen synthesis are associated with the pathogenesis of abdominal aortic aneurysms. Ann NY Acad Sci 800:216-228, 1996.

6. Cohen JR , Mandell C , Chang JB , et al: Elastin metabolism of the infrarenal aorta. J Vasc Surg 7:210-214, 1988.

7. Busuttil RW , Abou-Zamzam AM , Machleder HI : Collagenase activity of the human aorta. A comparison of patients with and without abdominal aortic aneurysms. Arch Surg 115:1373-1378, 1980.

8. Busuttil RW , Rinderbriecht H , Flesher A , et al: Elastase activity: The role of elastase in aortic aneurysm formation. J Surg Res 32:214-217, 1982.

9. Gregory AK , Hingorani AP , Tilson MD : Genetics of abdominal aortic aneurysmal disease. In: Current Therapy in Vascular Surgery, ed. 3, ed. by Ernst CB , Stanley JC . St. Louis: Mosby-Year Book, Inc, 1995, pp 198-200.

10.

10. Zarins CK : Pathogenesis of aortic aneurysms. In: Current Therapy in Vascular Surgery, ed. 3, ed. by Ernst CB , Stanley JC . St. Louis: Mosby-Year Book, Inc, 1995, pp 200-203.

11.

11. Thompson RW , Baxter BT : MMP inhibition in abdominal aortic aneurysms. Rationale for a prospective randomized clinical trial. Ann NY Acad Sci 878:159-178, 1999.

12.

12. Wilmink AB , Quick CR , Hubbard CS , et al: The association between connective tissue laxity and the risk of an abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 20:290-295, 2000.

13.

13. Rehm JP , Grange JJ , Baxter BT : The formation of aneurysms. Semin Vasc Surg 11:193-202, 1998.

14.

14. Grange JJ , Davis V , Baxter BT : Pathogenesis of abdominal aortic aneurysm: An update and look toward the future. Cardiovasc Surg 5:256-265, 1997.

15.

15. Cassina PC , Hailemariam S . Schmid RA , et al: Infrainguinal aneurysm formation in arterialized autologous saphenous vein grafts. J Vasc Surg 28:944-948, 1998.

16.

16. Alexander JJ , Liu YC : Atherosclerotic aneurysm formation in an in situ saphenous vein graft. J Vasc Surg 20:660-664, 1994.

17.

17. Loftus IM , McCarthy MJ , Lloyd A , et al: Prevalence of true vein graft aneurysms: Implications for aneurysm pathogenesis. J Vasc Surg 29:403-408, 1999.

18.

18. Upchurch GR Jr , Gerhard-Herman MD , Sebastian MW , et al: Improved graft patency and altered remodeling in infrainguinal vein graft reconstruction for aneurysmal versus occlusive disease. J Vasc Surg 29:1022-1030, 1999.

19.

19. Salles-Cunha SX , Beebe HG : Modern blood flow measurement techniques in the study of lower extremity arterial bypass grafts. Medica Mundi 40:32-36, 1995.