Swedish Registry Evaluates Popliteal Artery Aneurysms in Women
November 15, 2017—Findings from a study on popliteal artery aneurysms in women were published by Hans Ravn, MD, et al online ahead of print in European Journal of Vascular and Endovascular Surgery (EJVES). The background of the investigation is that 95% of patients who undergo operations for popliteal artery aneurysms are men, and thus, it is difficult to collect and study data on women who have this disease presentation.
In the study, women who were treated for popliteal artery aneurysms from 1987 to 2012 and prospectively registered in the Swedish Vascular Registry (Swedvasc), supplemented by case records, were compared with the larger male cohort. Survival was determined through cross-linkage with the National Population Registry.
The study identified 1,509 patients (men and women) and 1,872 legs; of these, 74 patients (4.9%) were women with disease in 81 legs (4.3%). The median age was 70 years in women versus 69 years in men. Twenty-nine centers operated on women (range, 1–7 women per center).
As summarized in EJVES, the investigators found that there were no time trends in the proportion of women operated on (P = .5). Bilateral popliteal artery aneurysms occurred in 9.5% of women and 27% of men (P = .002). For symptomatic aneurysms, there was a larger proportion of small aneurysms (< 2 cm) among women than men (24% vs 8%; P = .005), and there was no such difference in asymptomatic aneurysms. Distribution between asymptomatic and symptomatic popliteal artery aneurysms was 31% versus 69%, which was similar to men. The prevalence of concomitant aneurysms in the aortoiliac and femoral arteries and the frequency of presenting symptoms were similar compared with men.
In women, three popliteal artery aneurysms were ruptured (3.7%). Thrombolysis was used in 23 of 45 legs treated for acute ischemia (51%). Eight legs were treated with endovascular stent grafts (9.8%) compared with 7.9% in men (P = .5). Seven legs were amputated (8.6%). Crude survival was similar to men.
The investigators concluded that popliteal artery aneurysms are similar in women and men, but bilateral disease was less common in women and symptomatic PAs were more often < 2 cm in diameter. Women had the same survival as men, despite women generally having better life expectancy. Although it is the largest series ever published on women with popliteal artery aneurysms, the sample size is small, making it prone to type II statistical error, noted the investigators in EJVES.