1
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Satam K, Brahmandam A, Zheng X, Mao J, Goodney P, Ochoa Chaar CI. Long-term outcomes of elective endovascular vs open repair of popliteal artery aneurysms in the VISION database. J Vasc Surg 2025; 81:672-681.e2. [PMID: 39454844 DOI: 10.1016/j.jvs.2024.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/10/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND The best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single-center studies suggest that open popliteal aneurysm repair (OPAR) is more durable than endovascular PAR (EPAR), but large, randomized, multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database. METHODS VQI Medicare-linked VISION database (2010-2019) for peripheral vascular interventions and infrainguinal bypass were reviewed for elective PAR. Patients undergoing OPAR and EPAR were propensity matched to compare outcomes. RESULTS There were 1159 PARs (65.1% open). EPAR patients were older (77 years vs 73 years; P < .001) and more likely to be on P2Y12 inhibitors (26.5% vs 17.0%; P < .001). After matching, there were 396 patients in each group with similar baseline characteristics. EPAR patients were more likely to be discharged home (87.6% vs 48.5%; P < .001) and have a shorter hospital length of stay (1 day vs 3 days; P < .001). Kaplan-Meier curves showed no difference in mortality, reintervention, or major amputation at 1, 3, and 5 years. Cox proportional hazards regression showed no significant association between revascularization strategy and mortality, reintervention, or major amputation. Subgroup analysis of patients undergoing OPAR with great saphenous vein (GSV) bypass compared with EPAR showed that OPAR with GSV bypass was associated with lower mortality without difference in reintervention or major amputation. CONCLUSIONS Elective EPAR is durable and comparable with OPAR in terms of limb outcomes, even when GSV is used as conduit. However, bypass with GSV was associated with increased survival after open PAR compared with endovascular therapy.
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Affiliation(s)
- Keyuree Satam
- Division of Vascular Surgery, Stanford University, Stanford, CA.
| | - Anand Brahmandam
- Division of Vascular Surgery, Northwestern University, Evanston, IL
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Philip Goodney
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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2
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Demas N, Saha SP. Popliteal artery aneurysm repair-A single center experience. Asian Cardiovasc Thorac Ann 2024; 32:157-163. [PMID: 38295334 DOI: 10.1177/02184923241229467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Popliteal artery aneurysms (PAAs) are relatively rare but are one of the most common peripheral arterial aneurysms. Open popliteal artery aneurysm repair (OPAR) has been the standard, but technological advancements have made endovascular popliteal artery aneurysm repair (EPAR) a promising alternative. The aim of this study is to compare EPAR and OPAR efficacy and outcomes over a 10-year period. METHODS This study retrospectively reviewed 72 patient charts who were diagnosed with PAA or popliteal artery pseudoaneurysm and underwent EPAR or OPAR from 1 January 2010 to 31 December 2019. Endovascular popliteal artery aneurysm repair was used in 37 cases and OPAR in 35 cases. RESULTS Graft patency <30 days postoperative was 100% in both EPAR and OPAR groups. Graft patency >90 days postoperative was 72.73% in the EPAR group and 82.35% in the OPAR group (p = 0.477). Graft patency >2 years postoperative was 81.25% in the EPAR group and 86.67% in the OPAR group (p = 0.682). Freedom from reoperation 30-day postoperative was 78.38% in the EPAR group and 80% in the OPAR group (p = 0.865). Freedom from amputation 30-day postoperative was 91.43% in the EPAR group and 94.29% in the OPAR group (p = 0.263). The 30-day survival rate was 94.59% in the EPAR group and 100% in the OPAR group. CONCLUSIONS Endovascular repair represents a promising alternative for PAA repair. Our results demonstrate that EPAR has similar outcomes for asymptomatic, acutely symptomatic, and chronic symptomatic patients. Technological advancements of stent properties and refinement of surgical techniques may further improve endovascular techniques.
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Affiliation(s)
- Nicholas Demas
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Sibu P Saha
- Divison of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, KY, USA
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3
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Rebelo A, Partsakhashvili J, Ronellenfitsch U, John E, Kleeff J, Ukkat J. Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair. Vascular 2024; 32:32-41. [PMID: 38308424 DOI: 10.1177/17085381221126318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. METHODS A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg. RESULTS We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group. CONCLUSION Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.
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Affiliation(s)
- Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jumber Partsakhashvili
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Endres John
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
| | - Jörg Ukkat
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Germany
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4
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Nagar HJ, Bungay P, Podlasek A, Pollock JG. Endovascular Popliteal Artery Aneurysm Repair Using an "Off-Label" Abdominal Endograft Limb-Module with Nitinol-Ring Structure: A Single Centre Experience. Cardiovasc Intervent Radiol 2023; 46:1562-1570. [PMID: 37759089 DOI: 10.1007/s00270-023-03541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/12/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To evaluate endovascular popliteal artery aneurysm repair using a an "off-label" abdominal endograft limb-module with nitinol-ring structure. MATERIALS AND METHODS Retrospective observational study of 14 popliteal artery aneurysms in 12 male patients (mean age 76 years and median ASA grade 3) treated electively using the Anaconda™ endograft limb (Terumo Aortic) at a single teaching hospital. Eight limbs were treated percutaneously and 6 limbs required surgical arterial exposure. The mean popliteal artery aneurysm diameter treated was 3.6 cm (range 2.1-5.3 cm). Stent-graft diameters and lengths used were 10-15 and 60-140 mm, respectively. The median covered stented length was 218 mm (range 160-270 mm) and median duration of follow-up was 3.7 years. Outcomes assessed included technically successful aneurysm exclusion, primary patency, re-intervention and survival. RESULTS All patients had successful stent-graft deployment and aneurysm exclusion, with no early complications or mortality at 30 days. Primary stent-graft patency at 1, 3 and 4 years was 93%, 75%, and 64%. By 8 years, patency had declined with 29% (2/14) stent-grafts patent. 7/14 limbs occluded; 3 underwent re-intervention (2 surgical, 1 endovascular). There were no deaths related to the procedure. Freedom from re-intervention and survival at 1/5 years was 93%/84% and 93%/67%, respectively. CONCLUSION The Anaconda™ endograft limb for endovascular popliteal artery aneurysm repair offers good mid-term patency and acceptable long-term patency up to 4 years when compared with other grafts and open surgery. It may be considered in older comorbid patients unfit for surgery and can be performed percutaneously under local anaesthesia when anatomically feasible.
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Affiliation(s)
- H J Nagar
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - P Bungay
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - A Podlasek
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK
| | - J G Pollock
- Department of Vascular and Interventional Radiology, University Hospitals of Derby and Burton NHS Trust, Derbyshire, UK.
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5
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Wrede A, Acosta S, Lehti L, Lorenzen US, Zielinski AH, Eiberg JP. Endoleak following endovascular repair of popliteal artery aneurysm: clinical outcome and contrast-enhanced ultrasound detection. INT ANGIOL 2023; 42:26-32. [PMID: 36751984 DOI: 10.23736/s0392-9590.22.04983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Continued blood flow in the aneurysm sac after repair, also known as endoleak, can occur after both open and endovascular popliteal aneurysm repair (EPAR) with risk for aneurysm sac enlargement. Primary aims were to investigate aneurysm sac growth and the presence and classification of endoleak after EPAR using contrast-enhanced ultrasound (CEUS). METHODS Cross-sectional study of patients receiving EPAR with expanded polytetrafluorethylene (ePTFE) covered stent-grafts between 1st of January 2009 and 1st of February 2019 at a tertiary referral endovascular center. Patients were re-invited in 2021 and 31 legs were examined for endoleak using CEUS. Endoleaks were classified by a core-lab consisting of three CEUS-experienced physicians. RESULTS Median follow-up was 57 months (range 33-143 months). Endoleak was detected in 16 PAA, and categorized as type I (N.=3), type II (N.=10), type III (N.=1) or indeterminate (N.=2). Median maximal PAA diameter was 24 mm (range 15-55 mm) at the time of EPAR compared to 17 mm (range 6-43 mm) at follow-up (P<.001). Maximal aneurysm sac diameter was smaller at follow-up than at the index procedure in both PAAs with and without endoleak on CEUS (P=0.005 vs. P<0.001, respectively). There was no difference in PAA sac shrinkage at follow-up between patients with or without endoleak (P=0.28). Freedom from aneurysm sac growth was 97%. CONCLUSIONS CEUS was sensitive in endoleak detection after EPAR. Shrinkage of the PAA sac was found in both patients with and without endoleaks. CEUS appears useful for targeted examinations rather than routine surveillance after EPAR.
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Affiliation(s)
- Axel Wrede
- Department of Clinical Sciences, Lund University, Malmö, Sweden -
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Leena Lehti
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Ulver S Lorenzen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Alexander H Zielinski
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
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6
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Open Repair versus Endovascular Repair in The Treatment of Symptomatic Popliteal Artery Aneurysms. Ann Vasc Surg 2022; 86:77-84. [PMID: 35870674 DOI: 10.1016/j.avsg.2022.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Endovascular and open surgical modalities are currently used to treat popliteal artery aneurysms (PAA). However, there is limited data on the comparative durability of both repairs to guide physicians especially in the treatment of patients presenting symptomatic. We aimed to study the comparative effectiveness of endovascular PAA repair (EPAR) versus open PAA repair (OPAR). METHODS The vascular quality initiative (VQI)-Medicare linked database was queried for patients with symptomatic PAA who underwent OPAR or EPAR from January 2010 to December 2018. Kaplan-Meier estimates, log rank tests and multivariable Cox proportional hazard regression were employed to study the outcomes of amputation free survival (AFS), freedom from major amputation, and overall survival in 2 years following the index procedure. RESULTS A total of 1375 patients were studied, of which 23.7% (n=326) were treated with EPAR. Patients treated with OPAR were younger, less likely to have coronary artery disease (CAD) and chronic kidney disease (CKD), but more likely to be smokers and to present with acute lower extremity ischemia. OPAR patients had better 2-year AFS (84.5% vs. 72.5%, P<0.001) and overall survival (86.2% vs 74.7%, P<0.001). Freedom from major amputation at 2 years was comparable between EPAR and OPAR (95.5% vs 97.7%, P=0.164) in the overall cohort. Within the sub cohort of patients with acute limb ischemia, freedom from major amputation was significantly higher for OPAR compared to EPAR (97.4% vs. 90.6%, P=0.021). After adjustment for confounders, OPAR was associated with decreased risk of amputation or death (aHR, 0.62; 95%CI, 0.48-0.80; P<0.001) and mortality (aHR, 0.63; 95%CI, 0.48-0.81; P<0.001) at 2 years. OPAR and EPAR had comparable adjusted risk of 2-year major amputation in the overall cohort. However, for patients presenting with acute limb ischemia OPAR was associated with 72% lower risk of 2-year major amputation compared to EPAR (aHR, 0.28; 95%CI, 0.10-0.83; P=0.021). CONCLUSION In this multi-institutional observational study of symptomatic popliteal aneurysms, OPAR was associated with significantly better amputation free and overall survival compared to EPAR. For patients with acute ischemia, OPAR was associated with reduced risk of amputation. These findings suggest that OPAR may be superior to EPAR in the treatment of symptomatic PAA. A consideration of OPAR as first line definitive treatment for symptomatic PAA patients who are good surgical candidates is suggested.
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7
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Quintero-Pérez C, Manresa-Manresa F, García-de Vargas A, Mengíbar-Fuentes L, Bataller-de Juan E. Endovascular treatment of popliteal artery aneurysm in high-risk surgical patients. Cir Esp 2022; 100:448-450. [PMID: 35533838 DOI: 10.1016/j.cireng.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/16/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Claudia Quintero-Pérez
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | | | - Antonio García-de Vargas
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lucas Mengíbar-Fuentes
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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8
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Gujja K, Purushottam B, Kapur V, Cox‐Alomar PR, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Surgical Treatment of Asymptomatic Popliteal Artery Aneurysms and Mid-term Outcome. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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10
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Tayfur K, Bademci MŞ. Popliteal artery aneurysms treatments: early midterm results of the use of endovascular stent grafts. Turk J Med Sci 2021; 51:1106-1114. [PMID: 33356034 PMCID: PMC8283443 DOI: 10.3906/sag-2005-263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background/aim Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data. Material and methods A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel tortuosity, the presence and degree of thrombus, and diameter in the healthy landing zone and to visualize tibioperoneal vascular structures. A Viabahn stent graft was inserted in all patients. Results 57 patients (90.5%) were males with a mean age of 76.35
±
7 years. 24 patients (38.1%) were symptomatic, while 11 patients (17.5%) had a concomitant abdominal aortic aneurysm (AAA). The mean follow-up period was 46.05
±
25.01 months. The primary patency rate was 79.3%. A graft thrombosis was observed in 13 patients (20.6%) during a mean follow-up period of 8.31
±
5.91 months. The number of distal arteries was significantly lower in the patients with thrombosis than those without. Conclusions Endovascular treatment of PAA using stentgrafts is safe in selected cases. However, it is reasonable to avoid endovascular treatment due to an increased risk for thrombosis in patients with a low number of patent distal arteries or impaired distal flow.
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Affiliation(s)
- Kaptanıderya Tayfur
- Department of Cardiovascular Surgery, Faculty of Medicine, Ordu University, Ordu Training and Research Hospital, Ordu, Turkey
| | - Mehmet Şenel Bademci
- Department of Cardiovascular Surgery, Faculty of Medicine, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
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11
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Quintero-Pérez C, Manresa-Manresa F, García-de Vargas A, Mengíbar-Fuentes L, Bataller-de Juan E. Endovascular treatment of popliteal artery aneurysm in high-risk surgical patients. Cir Esp 2021; 100:S0009-739X(21)00182-2. [PMID: 34144810 DOI: 10.1016/j.ciresp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 03/15/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Claudia Quintero-Pérez
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - Antonio García-de Vargas
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Lucas Mengíbar-Fuentes
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen del Rocío, Sevilla, España
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12
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Beuschel B, Nayfeh T, Kunbaz A, Haddad A, Alzuabi M, Vindhyal S, Farber A, Murad MH. A systematic review and meta-analysis of treatment and natural history of popliteal artery aneurysms. J Vasc Surg 2021; 75:121S-125S.e14. [PMID: 34058308 DOI: 10.1016/j.jvs.2021.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize the best available evidence comparing open vs endovascular popliteal artery aneurysm (PAA) repair. We also summarized the natural history of PAAs to support of the Society for Vascular Surgery guidelines. METHODS We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate. RESULTS We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30 days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3 years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30 days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. One study showed that at 5 years, approximately one-half of the patients had complications. CONCLUSIONS This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.
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Affiliation(s)
- Brad Beuschel
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Tarek Nayfeh
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Ahmad Kunbaz
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Abdullah Haddad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Muayad Alzuabi
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Shravani Vindhyal
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn.
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13
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Shah NG, Rokosh RS, Garg K, Safran B, Rockman CB, Maldonado TS, Sadek M, Lamparello P, Jacobowitz GR, Barfield ME, Veith F, Cayne NS. Endovascular treatment of popliteal artery aneurysms has comparable long-term outcomes to open repair with shorter lengths of stay. J Vasc Surg 2021; 74:1565-1572.e1. [PMID: 33957229 DOI: 10.1016/j.jvs.2021.04.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE During the past two decades, the treatment of popliteal artery aneurysms (PAAs) has undergone a transformation. Although open surgical repair (OR) has remained the reference standard for treatment, endovascular repair (ER) has become an attractive alternative for select patient populations. The objective of the present study was to compare the outcomes of OR vs ER of PAAs at a single institution. METHODS We performed a retrospective review of the medical records for all patients who had undergone repair for PAAs from 1998 to 2017. The baseline patient, anatomic, and operative characteristics and outcomes were compared between the OR and ER cohorts. Intervention and treatment were at the discretion of the surgeon. RESULTS From 1998 to 2017, 64 patients had undergone repair of 73 PAAs at our tertiary care center. Of the 69 patients (73 PAAs), 29 (33 PAAs) had undergone OR and 35 (40 PAAs) had undergone ER. When comparing the two cohorts, no statistically significant differences were found in the demographic characteristics such as age, gender, or number of runoff vessels. Significantly more patients in the ER group (n = 21; 53%) than in the OR group (n = 7; 21%) had had hyperlipidemia (P = .008) and a previous carotid intervention (6% vs 0%; P = .029). Overall, the presence of symptoms was similar between the two groups. However, the OR group had a significantly higher number of patients who had presented with acute ischemia (P = .01). The length of stay was significantly shorter for the ER cohort (mean, 1.8 days; range, 1-11 days) than for the OR group (mean, 5.4 days; range, 2-13 days; P < .0001). No significant difference was found in the primary or secondary patency rates between the two groups. In the ER group, good runoff (two or more vessels) was a positive predictor for primary patency at 1 year (odds ratio, 3.36; 95% confidence interval, 1.0-11.25). However, it was not in the OR group. Postoperative single and/or dual antiplatelet therapy did not affect primary patency in either cohort. CONCLUSIONS The results of our study have demonstrated that ER of PAAs is a safe and durable option with patency rates comparable to those with OR and a decreased length of stay, with good runoff a positive predictor for primary patency in the ER cohort.
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Affiliation(s)
- Noor G Shah
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Rae S Rokosh
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Brent Safran
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Caron B Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Patrick Lamparello
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Glenn R Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Michael E Barfield
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Frank Veith
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY
| | - Neal S Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY.
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Open Endoaneurysmorrhaphy of 9-cm Ruptured Popliteal Aneurysm 7 Years after Initial Repair. Ann Vasc Surg 2020; 72:665.e9-665.e13. [PMID: 33227480 DOI: 10.1016/j.avsg.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND A previously repaired right popliteal artery aneurysm via a medial approach with proximal and distal ligation and interval bypass re-presented 7 years after the initial repair with a ruptured 9 × 25.5 cm right popliteal aneurysm. METHODS Surgical repair was complex due to the large size of the aneurysm. Technique and management of popliteal aneurysm repair are discussed, along with a review of the current literature. RESULTS A 58-year-old male with a 3.5 cm popliteal artery aneurysm was initially treated with end-to-end prosthetic bypass and proximal/distal aneurysm ligation from a medial-approach without complication. Seven years later, he presented with a 9-cm popliteal aneurysm rupture. Posterior approach endoaneurysmorrhaphy repair was far more complicated than expected with massive blood loss. Despite this, he was discharged without complication POD #5, but on POD #19 presented with cellulitis and underwent incision and drainage of retained hematoma with cultures positive for Strep dysgalactiae. With appropriate treatment, he was healed in 3 months. CONCLUSIONS Surgical repair of large popliteal aneurysms can be challenging, but continued aneurysmal degeneration is a potential consequence if the sac continues to be pressurized from patent geniculate arteries. Surgical repair of large popliteal artery aneurysms is complex and requires adjunctive techniques to maximize success. A posterior approach is described and the literature reviewed to support recommendations for primary popliteal artery aneurysm repair and repair of large degenerated popliteal artery aneurysms. We recommend primary popliteal artery aneurysm repair from a posterior approach with endoaneurysmorrhaphy and an interposition bypass. For ruptured large popliteal artery aneurysms, there is a high risk of hemorrhage and wound complications. Therefore, we recommend the use of a tourniquet, surgical drain and to consider the collection of intraoperative cultures to guide potential antibiotic management.
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15
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Seiler R, Turkalj I, Gähwiler R, Isaak A, Thalhammer C, Rastan A. Symptomatic type I endoleak following popliteal artery aneurysm repair. VASA 2020; 49:514-517. [PMID: 32697149 DOI: 10.1024/0301-1526/a000899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of a symptomatic type Ib endoleak following popliteal artery aneurysm repair with successful interventional therapy introduces a short review of the limited literature to this relevant potential complication. Illustration of important factors supporting endoleak formation after endovascular popliteal artery repair and recommendation of a consequent surveillance are discussed.
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Affiliation(s)
- Rebekka Seiler
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
| | - Igor Turkalj
- Health Centre Fricktal, Internal Medicine, Laufenburg, Switzerland
| | - Roman Gähwiler
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
| | - Andrej Isaak
- Vascular Surgery, University Centre Aarau-Basel, Aarau, Switzerland
| | | | - Aljoscha Rastan
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
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16
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Aragão JA, de Miranda FGG, Aragão ICS, Aragão FMS, Reis FP. Treatment of bilateral popliteal artery aneurysms. J Vasc Bras 2019; 19:e20180142. [PMID: 31839798 PMCID: PMC6900880 DOI: 10.1590/1677-5449.180142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities.
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Affiliation(s)
- José Aderval Aragão
- Universidade Federal de Sergipe - UFS, Aracaju, SE, Brasil.,Universidade Tiradentes - UNIT, Aracaju, SE, Brasil
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17
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Ríos A, Carrillo J, Capel A. Embolización de seudoaneurisma femoral secundario a contusión por asta de toro. Cir Esp 2019; 97:353-355. [DOI: 10.1016/j.ciresp.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/08/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
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18
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Abstract
Popliteal artery aneurysms (PAAs) are the most common peripheral artery aneurysms. They are frequently symptomatic and are associated with high rates of morbidity and limb loss. PAA can be treated by open or endovascular means, although there are no specified recommendations guiding treatment choice. This article delineates many of the differences between open and endovascular repair of asymptomatic PAA, and highlights several key articles comparing open and endovascular repair to guide decision making. Proper diagnosis and choice of repair can lead to good outcomes in the treatment of asymptomatic PAA.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of General Surgery, Yale University, New Haven, Connecticut
| | - Bauer E Sumpio
- Division of Vascular Surgery, Department of General Surgery, Yale University, New Haven, Connecticut
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19
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Golchehr B, Zeebregts CJ, Reijnen MM, Tielliu IF. Long-term outcome of endovascular popliteal artery aneurysm repair. J Vasc Surg 2018; 67:1797-1804. [DOI: 10.1016/j.jvs.2017.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023]
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20
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Ucci A, Curci R, Azzarone M, Bianchini Massoni C, Bozzani A, Marcato C, Marone EM, Perini P, Tecchio T, Freyrie A, Argenteri A. Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator. Vascular 2018; 26:556-563. [PMID: 29665749 DOI: 10.1177/1708538118771258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.
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Affiliation(s)
- Alessandro Ucci
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Ruggiero Curci
- 2 Unit of Vascular and Endovascular Surgery, ASST Lodi, Maggiore Hospital, Lodi, Italy
| | - Matteo Azzarone
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Claudio Bianchini Massoni
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Bozzani
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Carla Marcato
- 4 Department of Diagnostic and Interventional Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Enrico Maria Marone
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paolo Perini
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Tiziano Tecchio
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Freyrie
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Angelo Argenteri
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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21
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Del Tatto B, Lejay A, Meteyer V, Roussin M, Georg Y, Thaveau F, Geny B, Chakfe N. Open and Endovascular Repair of Popliteal Artery Aneurysms. Ann Vasc Surg 2018; 50:119-127. [PMID: 29501897 DOI: 10.1016/j.avsg.2018.01.077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/29/2017] [Accepted: 01/06/2018] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Benjamin Del Tatto
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - Vincent Meteyer
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mathieu Roussin
- Department of Cardiovascular Surgery, Hôpital Mercy, Metz, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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22
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Bandeira RN, Cacione DG, Bandeira FCV, Pelissoni ADS, Leite CON, Nakano LCU. Tratamento endovascular versus tratamento aberto de aneurisma de artéria poplítea: artigo de revisão. J Vasc Bras 2018; 17:34-41. [PMID: 29930679 PMCID: PMC5990263 DOI: 10.1590/1677-5449.004917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O tratamento convencional do aneurisma da artéria poplítea é a cirurgia aberta de exclusão do aneurisma e revascularização do membro acometido. Nos últimos anos, o tratamento endovascular vem ganhando popularidade e interesse. O tratamento endovascular é menos invasivo e de menor morbidade; porém, é de alto custo e sua perviedade é incerta. O objetivo desta revisão é comparar os dois tratamentos através da análise de desfechos abordados em estudos primários e secundários. Realizou-se uma revisão narrativa da literatura publicada nos últimos 5 anos. Foram selecionados seis estudos retrospectivos, duas metanálises, um ensaio clínico e uma revisão sistemática Cochrane. Número limitado de pacientes e curto período de seguimento não nos permitem extrair conclusões consistentes. Não há evidência clara que sugere melhores resultados entre um ou outro tratamento eletivo. Novos ensaios randomizados devem ser realizados para determinar o papel do tratamento endovascular desse aneurisma.
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Affiliation(s)
| | - Daniel Guimarães Cacione
- Universidade Federal de São Paulo - UNIFESP, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | | | | | | | - Luis Carlos Uta Nakano
- Universidade Federal de São Paulo - UNIFESP, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Leake AE, Segal MA, Chaer RA, Eslami MH, Al-Khoury G, Makaroun MS, Avgerinos ED. Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg 2017; 65:246-256.e2. [PMID: 28010863 DOI: 10.1016/j.jvs.2016.09.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Endovascular popliteal artery aneurysm repair (EPAR) is increasingly used over open surgical repair (OPAR). The purpose of this study was to analyze the available literature on their comparative outcomes. METHODS The PubMed and Embase databases were searched to identify studies comparing OPAR and EPAR. Studies with only one treatment and fewer than five patients were excluded. Demographics and outcomes were collected. Bias risk was assessed using a modified version of the Newcastle-Ottawa Scale. Results were computed from random-effects meta-analyses using the DerSimonian-Laird algorithm. RESULTS A total of 14 studies were identified encompassing 4880 popliteal artery aneurysm repairs (OPAR, 3915; EPAR, 1210) during the last decade. OPAR patients were younger (standard mean difference, -0.798 [-0.798 to -1.108]; P < .001) and more likely to have worse tibial runoff (odds ratio [OR], 1.949 (1.15-3.31); P = .013) than EPAR patients. OPAR had higher odds of wound complications (OR, 5.182 [2.191-12.256]; P < .001) and lower odds of thrombotic complications (OR, 0.362 [0.155-0.848]; P < .001). OPAR had longer length of stay (standardized mean difference, 2.158 [1.225-3.090]; P < .001) and fewer reinterventions (OR, 0.275 [0.166-0.454]; P < .001). Primary patency was better for OPAR at 1 year and 3 years (relative risk, 0.607 [P = .01] and 0.580 [P = .006], respectively). There was no difference in secondary patency at 1 year and 3 years (0.770 [P = .458] and 0.642 [P = .073], respectively). CONCLUSIONS EPAR has a lower wound complication rate and shorter length of hospital stay compared with OPAR. This comes at the cost of inferior primary patency but not secondary patency out to 3 years. Studies reporting long-term outcomes are lacking and necessary.
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Affiliation(s)
- Andrew E Leake
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Michael A Segal
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Mohammad H Eslami
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Georges Al-Khoury
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthymios D Avgerinos
- Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Gujja K, Punukollu G, Kapur V, Krishnan P. Popliteal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karthik Gujja
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | | | - Vishal Kapur
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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Golchehr B, Tielliu I, Verhoeven E, Möllenhoff C, Antonello M, Zeebregts C, Reijnen M. Clinical Outcome of Isolated Popliteal Artery Aneurysms Treated with a Heparin-bonded Stent Graft. Eur J Vasc Endovasc Surg 2016; 52:99-104. [DOI: 10.1016/j.ejvs.2016.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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26
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Reliability of Ultrasound Diameter Measurements in Patients with a Small Asymptomatic Popliteal Artery Aneurysm: An Intra- and Inter-observer Agreement Study. Eur J Vasc Endovasc Surg 2016; 51:410-4. [PMID: 26804485 DOI: 10.1016/j.ejvs.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In this study the intra- and inter-observer variability of ultrasound measurements of the diameter of the popliteal artery were tested in a group of patients under surveillance for a small (diameter 10-20 mm), asymptomatic popliteal artery aneurysm (PAA). METHODS From a group of patients under ultrasound surveillance for bilateral, asymptomatic PAAs, 13 consecutive patients agreed to participate in the study and provided informed consent. The maximum diameter of the popliteal arteries was assessed by a vascular technologist. The same assessment was repeated by a second vascular technologist, unaware of the results of the first measurement. After a week, this protocol was repeated. The intra- and inter-observer reliability of this measurement was calculated using intra-class correlation coefficients (ICCs) and Bland and Altman plots. RESULTS Of the 10 patients with bilateral and three patients with unilateral PAA, 12 completed the 2 week protocol. A total of 86 measurements were analyzed. The mean diameter of the popliteal arteries was 13.5 ± 3.4 mm. The ICC for the intra-observer reliability of observer 1 was 0.96 (95% CI 0.92-0.99), p < .001 and of observer 2 was 0.98 (95% CI 0.95-0.99), p < .001. The ICC for the inter-observer reliability for the first measurements was 0.96 (95% CI 0.90-0.98), p < .001 and for the second measurements 0.97 (95% CI 0.94-0.99), p < .001. The Bland-Altman plots showed random error, while 95% of the variation was between 0.016 and 0.16, p > .47. The absolute magnitude of the systematic error of both observers was less than 0.135 mm (median 0.00). CONCLUSION Ultrasound measurement of the maximum diameter of the popliteal artery is reproducible; hence, it is suitable for making a clinical treatment decision. Its use for surveillance of small, asymptomatic PAAs is justified.
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