Thrombolysis or Immediate Surgery for Thrombosed Popliteal Aneurysms?

Open and Endovascular Repair of Popliteal Artery Aneurysms

BACKGROUND

The purpose of this study was to report midterm outcomes of open repair (OR) or endovascular repair (ER) of popliteal artery aneurysms (PAAs) and assess if outcomes of patients have changed in the endovascular era.

METHODS

This monocentric and retrospective study included all consecutive patients treated for PAA between January 2004 and December 2016. Before 2010, all patients underwent OR, but ER was available since 2010, and the choice between OR or ER was made on the basis of clinical presentation and preoperative morphological assessment. Survival, primary patency, primary-assisted patency, secondary patency, and limb salvage rates were assessed regarding the surgical way of treatment (OR or ER) or regarding the period of time (before 2010 or since 2010).

RESULTS

A total of 153 PAA were treated in 126 patients (103 limbs in OR and 50 limbs in ER). Mean follow-up was 3.8 years. Five-year survival was 97.7% for OR and 88.7% for ER. Five-year primary patency was 77.8% and 29.5% for OR and ER, respectively, primary-assisted patency 85.0% and 49.7%, respectively, and secondary patency 92.8% and 79.6%, respectively. Five-year limb salvage was 89.5% for OR and 87.9% for ER. No outcome difference was observed between patients who underwent surgery before or after ER was available.

CONCLUSIONS

Results of OR and ER in the setting of PAA are satisfactory. Outcomes of patients did not change in the endovascular era.

Long-term results of open repair of popliteal artery aneurysm

INTRODUCTION

Popliteal artery aneurysms (PAA) are rare. Different surgical techniques for open surgical repair are possible. This study presents a single centre experience using open surgical repair with a medial approach (MA) and outlines differences between symptomatic (SLS) and asymptomatic (ALS) legs.

METHODS

Data collection was performed retrospectively. The investigation period was from 1 January 1996 to 1 January 2013. Patients presented in the Outpatient Department and received a questionnaire concerning their quality of life. Data are presented as mean ± standard deviation. Mann-Whitney test and Cochran-Armitage test for trend was used for data analysis. Kaplan-Meier method was used to calculate limb salvage rates. p < 0.05 was considered statistically significant.

RESULTS

We analyzed 16 ALS and 26 SLS with an average age of 63.5 ± 10 years. Preoperative ankle-brachial index (ABI) was 1.0 ± 0.2 for ALS (on control examination: 1.12 ± 0.24) and 0.08 ± 0.18 for SLS (on control examination 0.94 ± 0.14) (p < 0.05). Limb salvage rate was 100% for ALS and 86.7% for SLS (overall 93.3%). Primary patency rate for SLS was 85%, for ALS rate of 100%, respectively (overall 92.5%). ALS reached an average of 13.1 ± 2.7 points (SLS 11.4 ± 2.8) on a numeric point scale.

CONCLUSION

Open surgery is therapy and prevention of acute ischaemia all in one, especially for asymptomatic patients and delivers good long-term results. Endovascular therapies offer an alternative but long-term results are pending. Open surgery should still be considered as a gold standard therapy.