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Freytag H, Kapalla M, Berg F, Stroth HCA, Reisenauer T, Stoklasa K, Zimmermann A, Reeps C, Knappich C, Wolk S, Busch A. Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures. J Clin Med 2024; 13:2817. [PMID: 38792357 PMCID: PMC11122537 DOI: 10.3390/jcm13102817] [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: 03/23/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo-popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3-78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo-popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient's overall condition should be considered.
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Affiliation(s)
- Hannah Freytag
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Floris Berg
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hans-Christian Arne Stroth
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Tessa Reisenauer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Kerstin Stoklasa
- Department of Vascular Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Steffen Wolk
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
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da Silva MFA, Louzada ACS, Teivelis MP, Junior EA, Wolosker N. Nationwide cross-sectional epidemiological analysis of 3,306 lower limb peripheral aneurysm repairs in Brazilian public hospitals between 2008 and 2019: trends, mortality and costs. Ann Vasc Surg 2022; 84:21-27. [PMID: 35276353 DOI: 10.1016/j.avsg.2022.02.028] [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: 01/11/2022] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although peripheral aneurysms can be limb or life threatening, the literature is scarce and there are only two large population-based epidemiological studies on peripheral aneurysm repair, comprising data from high-income countries only. OBJECTIVE To evaluate the epidemiology of peripheral aneurysm repairs in the Brazilian Public Health System, which exclusively insures more than 160 million Brazilians. METHODS retrospective cross-sectional analysis on open and endovascular peripheral aneurysm repairs performed in public hospitals between 2008 and 2019 using a public database. RESULTS 3,306 peripheral aneurysm repairs were observed. Most patients were elderly (57.74%) male (72.66%) and patients treated with endovascular repair were older (p=0.008). Most repairs were emergency (59.56%) and open (93.8%) and there was an overall downward trend in procedure rates. We observed a decreasing predominance of emergency open repair over elective open repair (p<0.001), but open repairs prevailed over endovascular procedures, with no tendency to change this predominance. Mortality rates were 3.12% and 3.67% after elective and emergency open repair, respectively, with no difference, and 0 and 4.24% for elective and emergency endovascular repair, respectively. The government reimbursed an average of $1170.05 for open PA repair and $1802.01 for endovascular repair. CONCLUSIONS We presented the largest series of the literature analyzing all 3,306 lower limb peripheral aneurysm repairs performed in public hospitals in a middle-income country. Procedure rates tended to decrease. Open repair predominated. Mortality rates ranged from 0 to 4%. Most procedures were emergency, but there was a relative increase of elective treatments over the years.
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Affiliation(s)
| | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Edson Amaro Junior
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; São Paulo University Medical School, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil; São Paulo University Medical School, São Paulo, SP, Brazil
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Mariño JLD, Gallego ELM, Arias FR, Carballo EP, Muñoz CST, Romero EG. Results of Surgical Treatment for Popliteal Aneurysm. Ann Vasc Surg 2021; 80:370-378. [PMID: 34775014 DOI: 10.1016/j.avsg.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/09/2021] [Accepted: 09/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Evaluate the results of open surgery treatment of popliteal artery aneurysms (PAAs), performed in our department for over 25 years, comparing those treated with a medial approach with those treated with a posterior approach. MATERIAL AND METHOD A retrospective analysis of a total of 88 PAAs, performed between January 1994 and December 2018, with an average of 65 months follow-up, comparing the results of 59 patients operated by a medial approach (group 1) in which aneurysm exclusion and femoro-popliteal bypass below the knee was carried out, with 29 cases treated by a direct posterior approach (group 2) - aneurismectomy and graft interposition-. The postoperative complications, immediate and long term patency, limb salvage and mortality rate were studied. RESULTS In group 1 the chosen material for the bypass was reversed greater saphenous vein (GSV) in 45 cases (76.3%), expanded polytetrafluoroethylene (ePTFE) grafts in 12 (20.3%) and Dacron grafts on 2 (3.4%), while in group 2, a 6 mm diameter ringed ePTFE graft was used in 27 cases (93.1%) and reversed GSV in 2 (6.9%). There were eight (13.6%) postoperative graft thrombosis in group 1, 5 (8.9%) of them needing amputation, and 1 (3.4%) graft thrombosis in group 2 (P = 0.077). During the follow up, major amputation was necessary in 2 cases (3.7%) in group 1, while there were no cases of major amputation in group 2. Mortality was 61% (36 patients) in group 1 and 27% (8 patients) in group 2 (p = 0.003), at the end of surveillance. CONCLUSION In our experience, in the open surgical treatment of PAAs, the posterior approach could be considered as the first choice in selected cases.
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Affiliation(s)
| | | | | | - Eva Pérez Carballo
- Vascular Surgery Department, Universitary Hospital Lucus Augusti, Lugo, Spain
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MUNARI E, DUCASSE E, CARADU C. Fatal myonephropathic metabolic syndrome after surgical repair of popliteal aneurysm rupture with distal occlusion. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chang H, Veith FJ, Rockman CB, Siracuse JJ, Jacobowitz GR, Cayne NS, Patel VI, Garg K. Comparison of Outcomes for Open Popliteal Artery Aneurysm Repair Using Vein and Prosthetic Conduits. Ann Vasc Surg 2021; 75:69-78. [PMID: 33819593 DOI: 10.1016/j.avsg.2021.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/14/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Autologous vein is considered the preferred conduit for lower extremity bypass. There is, however, limited literature regarding conduit choice for open popliteal artery aneurysm (PAA) repair. We sought to compare outcomes of PAA repair using vein versus prosthetic conduits. METHODS The Vascular Quality Initiative database (2003-2019) was queried for patients with PAAs undergoing elective conventional revascularization originating from the superficial femoral and popliteal arteries. Conduits were categorized as vein or prosthetic. Primary outcomes were primary graft patency, freedom from major adverse limb event (MALE) and MALE-free survival at 2-years. Kaplan-Meier method with log-rank tests was used for estimation and comparison of patency. RESULTS A total of 1,146 limbs in 1,065 patients underwent elective open revascularization for PAA. Vein was used in 921 limbs (80%), and prosthetic in 225 (20%). Patients in the prosthetic cohort had a shorter procedure time, were older, and had a higher prevalence of COPD. Postoperatively, prosthetic patients were more likely to be started and maintained on anticoagulation without increased incidence of hematoma. There was no significant difference in the rate of surgical site infection (2% vs. 2%; P = 0.946). There was an increased tendency toward more symptomatic patients in the vein cohort although not statistically significant (49% vein vs. 41% prosthetic; P = 0.096). On a mean follow-up of 13 ± 5 months, the incidence of MALE and MALE-free survival were comparable between the two groups. The 2-year primary and secondary patency rates were similar, 87% and 96% in the vein, and 91% and 95% in the prosthetic groups, respectively. At multivariable analysis, outflow bypass targets to the infrapopliteal arteries (HR 2.05; 95% confidence interval (CI), 1.16-3.65; P = 0.014) and symptomatic aneurysm (HR 1.81; 95% CI, 1.04-3.15; P = 0.037) were independently associated with loss of primary patency. Conduit type did not make a difference in MALE-free survival, or primary graft patency at 2-years. CONCLUSION Our study demonstrates that conventional open PAA repair with prosthetic conduit yields results comparable to those with vein conduit with regard to primary and secondary patency and MALEs at 2-years for targets to the popliteal artery. However, when the distal target was infrapopliteal, worse outcomes were observed with prosthetic conduit. Our results suggest that vein conduit should be preferentially used for infrapopliteal targets, while prosthetic conduit confers comparable outcomes in a subset of patients who do not have suitable autologous vein conduits.
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Affiliation(s)
- Heepeel Chang
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Frank J Veith
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Caron B Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Glenn R Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Neal S Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Virendra I Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian / Columbia University Medical Center / Columbia University College of Physicians and Surgeons, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
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Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort. Eur J Vasc Endovasc Surg 2021; 61:988-997. [PMID: 33762154 DOI: 10.1016/j.ejvs.2021.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/22/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. METHODS A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 - 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 - 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. RESULTS Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 - 4.55, p < .001) for ER, but 3.03 (1.26 - 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 - 4.50, p = .003), but 4.68 (1.89 - 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 - 5.97], p = .003; and poor outflow HR 14.39 [3.46 - 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 - 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 - 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 - 2012 and 2014 - 2018). CONCLUSION In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.
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Grip O, Mani K, Altreuther M, Bastos Gonçalves F, Beiles B, Cassar K, Davidovic L, Eldrup N, Lattmann T, Laxdal E, Menyhei G, Setacci C, Settembre N, Thomson I, Venermo M, Björck M. Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. Eur J Vasc Endovasc Surg 2020; 60:721-729. [PMID: 32807672 DOI: 10.1016/j.ejvs.2020.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.
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Affiliation(s)
- Olivia Grip
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden.
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden
| | - Martin Altreuther
- Department of Vascular Surgery, St Olavs Hospital, Trondheim, Norway
| | | | - Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Kevin Cassar
- Vascular Unit, Department of Surgery, Mater Dei Hospital, Malta
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Centre, Belgrade, Serbia
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Thomas Lattmann
- Clinic of Vascular Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Elin Laxdal
- Department of Vascular Surgery, Landspitalinn University Hospital, Reykjavik, Iceland
| | - Gabor Menyhei
- Department of Vascular Surgery Medical Centre, Pecs University, Pecs, Hungary
| | | | - Nicla Settembre
- Department of Vascular and Endovascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
| | - Ian Thomson
- Department of Surgical Sciences, Otago University, Dunedin, New Zealand
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden
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Eligibility of Endovascular Repair for Popliteal Artery Aneurysms According the Instructions for Use. Ann Vasc Surg 2020; 67:370-375. [PMID: 32209408 DOI: 10.1016/j.avsg.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Popliteal artery aneurysms (PAAs) are the most common peripheral aneurysms. Although rare and often asymptomatic, there is a significant risk of thrombosis, embolism, and limb loss. The aim of this study was to evaluate the eligibility for endovascular repair of patients treated for symptomatic and asymptomatic PAAs in accordance with the instructions for use (IFU). METHODS All patients treated for PAA with open surgical repair between the years 2010 and 2017 were analyzed if suitable for endovascular treatment. Preoperative imaging was reviewed for applicability with an interventional radiologist and 2 vascular surgeons. Evaluation was performed in accordance with the following criteria adopted from the IFU of the Gore ® Viabahn stent graft: at least a single-vessel tibial runoff, proximal and distal landing zone more than 2 cm, no large difference in vessel diameter proximal and distal to the aneurysm, no overstenting of significant collaterals necessary, and no inadequate kinking of the artery. The patients were classified in 3 categories: the patient was eligible, endovascular treatment was feasible, and endovascular treatment was not appropriate. RESULTS 51 patients with 61 symptomatic and asymptomatic PAAs were identified. Forty-five cases were asymptomatic, 11 cases showed clinical symptoms such as claudication, and in 5 cases, the patients presented with acute ischemia. Twenty-four patients were eligible for endovascular intervention, 14 cases were feasible, and in 23 cases, it was not appropriate in accordance with the IFU. CONCLUSIONS In this study, more than one-third of the patients with PAA were not eligible for endovascular treatment in accordance with the IFU and another 23 % showed substantial reasons against endovascular treatment. These data suggest that endovascular repair remains a treatment option for selected patients only. Cross-sectional imaging is mandatory for procedure selection.
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Joshi D, Gupta Y, Ganai B, Mortensen C. Endovascular versus open repair of asymptomatic popliteal artery aneurysm. Cochrane Database Syst Rev 2019; 12:CD010149. [PMID: 31868929 PMCID: PMC6927522 DOI: 10.1002/14651858.cd010149.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Popliteal artery aneurysm (PAA) is a focal dilatation and weakening of the popliteal artery. If left untreated, the aneurysm may thrombose, rupture or the clot within the aneurysm may embolise causing severe morbidity. PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. The success of the procedure is gauged by the ability of the graft to stay patent over an extended duration. While surgical treatment is usually preferred in an emergency, the evidence on first line treatment in a non-emergency setting is unclear. This is an update of a review first published in 2014. OBJECTIVES To assess the effectiveness of an endovascular stent graft versus conventional open surgery for the treatment of asymptomatic popliteal artery aneurysms (PAA) on primary and assisted patency rates, hospital stay, length of the procedure and local complications. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 29 January 2019. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing endovascular stent grafting versus conventional open surgical repair in patients undergoing unilateral or bilateral prophylactic repair of asymptomatic PAAs. DATA COLLECTION AND ANALYSIS We collected data on primary and assisted primary patency rates (primary endpoints) as well as operating time, the length of hospital stay, limb salvage and local wound complications (secondary endpoints). We presented results as risk ratio or mean difference with 95% confidence intervals and assessed the certainty of the evidence using GRADE. MAIN RESULTS No new studies were identified for this update. A single RCT with a total of 30 PAAs met the inclusion criteria. There was a low risk of selection bias and detection bias. However, the risks of performance bias, attrition bias and reporting bias were unclear from the study. Despite being an RCT, the certainty of the evidence was downgraded to moderate due to the small sample size, resulting in wide confidence intervals (CIs); only 30 PAAs were randomised over a period of five years (15 PAAs each in the groups receiving endovascular stent graft and undergoing conventional open surgery). The primary patency rate at one year was 93.3% in the endovascular group and 100% in the surgery group (RR 0.94, 95% CI 0.78 to 1.12; moderate-certainty evidence). The assisted patency rate at one year was similar in both groups (RR 1.00, 95% CI 0.88 to 1.13; moderate-certainty evidence). There was no clear evidence of a difference between the two groups in the primary or assisted patency rates at four years (13 grafts were patent from 15 PAA treatments in each group; RR 1.00, 95% CI 0.76 to 1.32; moderate-certainty evidence); the effects were imprecise and compatible with the benefit of either endovascular stent graft or surgery or no difference. Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) -3.40 days, 95% CI -4.42 to -2.38; P < 0.001; moderate-certainty evidence). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD -119.90 minutes, 95% CI -137.71 to -102.09; P < 0.001; moderate-certainty evidence). Limb salvage was 100% in both groups. Data on local wound complications were not published in the trial report. AUTHORS' CONCLUSIONS Evidence to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs is limited to data from one small study. At one year there is moderate-certainty evidence that primary patency may be improved in the surgery group but assisted primary patency rates were similar between groups. At four years there was no clear benefit from either endovascular stent graft or surgery to primary or assisted primary patency (moderate-certainty evidence). As both operating time and hospital stay were reduced in the endovascular group (moderate-certainty evidence), it may represent a viable alternative to open repair of PAA. A large multicenter RCT may provide more information in the future. However, difficulties in recruiting enough patients are likely, unless it is an international collaboration including a number of high volume vascular centres.
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Affiliation(s)
- Dhiraj Joshi
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Yuri Gupta
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Bhaskar Ganai
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Chloe Mortensen
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
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Abstract
BackgroundRupture is a recognised complication of ruptured popliteal artery aneurysms that requires emergency intervention. There is little evidence collating the presentation, intervention and outcomes of ruptured popliteal artery aneurysms.ObjectiveThe primary aim of this study was to deduce the sequelae following different management modalities of ruptured popliteal artery aneurysm.MethodsWe performed a systematic review of all available cases reports of ruptured popliteal artery aneurysms in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocol.ResultsWe identified 48 cases taken from 35 case reports and series. Men were more commonly affected ( n = 96%), and mean age was 71 years. Acute limb ischemia was the commonest presentation (32%) whilst incidental deep vein thrombosis was found in 43% of patients. The mean aneurysm size was 8.2 cm (range, 2.7 to 13.3 cm). Management consisted of open surgery (58%), endovascular treatment (25%) and ‘other’ treatment (evacuation of haematoma, ligation of aneurysm, amputation or palliation) (17%). The perioperative mortality rate in the whole cohort was 13%. Perioperative mortality was similar between comparing the open and endovascular surgery groups. Re-intervention rate amongst endovascular patients was 25% over an average follow-up period of 14 months. There was one re-intervention in the re-constructive group (3%) over a follow-up period of 17 months and none in the ‘other’ group.ConclusionPopliteal artery aneurysm rupture is a serious complication associated with significant morbidity and mortality. Open surgical reconstruction and endovascular repair are both feasible for the treatment of ruptured popliteal artery aneurysms; however, open surgery is less likely to require further re-intervention.
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Affiliation(s)
- James Akman
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Emmanuel Katsogridakis
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.,2 Academic Surgery Unit, University Hospital of South Manchester, Manchester, UK
| | - George A Antoniou
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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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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Femoral artery transposition is a safe and durable option for the treatment of popliteal artery aneurysms. J Vasc Surg 2018; 68:510-517. [PMID: 29606570 DOI: 10.1016/j.jvs.2017.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/15/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE A suitable ipsilateral great saphenous vein (GSV) autograft is widely considered the best material for arterial reconstruction of a popliteal artery aneurysm (PAA). There are, however, cases in which such a GSV is absent, diseased, or of too small diameter for this use. Alternatives to GSV are synthetic conduits, but with a reduced long-term patency, in particular for infragenicular bypass; other venous autografts of marginal use; and stent grafts still in the first stages of their evaluation. However, a sufficiently long segment of the ipsilateral superficial femoral artery (SFA) is often preserved in patients with a PAA. Such a segment may be used as an autograft for popliteal reconstruction. Moreover, the morphometric characteristics of the SFA often optimally match those of the distal native popliteal bifurcation. SFA autografts (SFAAs) have therefore become our choice when the ipsilateral GSV is not suitable. We herein present the long-term results of SFAA for the treatment of PAA in the absence of a suitable GSV. METHODS Within this single-center study, all cases during the last 26 years were retrospectively reviewed. Demographics, risk factors, comorbidities, morphometrics of the PAA, and preoperative and follow-up data were intentionally sought. RESULTS From 1997 to 2017, there were 67 PAAs treated with an SFAA. The mean age of the patients was 67.67 ± 12 years, and 98% were male. Symptoms included intermittent claudication in 25% (17), critical limb ischemia in 7% (5), and acute ischemia in 10% (7) of the patients; 51% (34) of the patients were asymptomatic. The mean aneurysm diameter of the treated PAA was 29 ± 11 mm (12-61 mm). The mean operative time was 254.8 ± 65.6 minutes (140-480 minutes), with a mean cross-clamp time of 64.5 ± 39 minutes (19-240 minutes). The median length of stay was 9 ± 6.4 days (5-42 days). There were no early amputations or deaths in the series. During a mean follow-up of 47.91 ± 48.23 months, there were 2 anastomotic stenoses, 11 thromboses, 1 infection, and 1 aneurysmal degeneration of the graft; 6 patients died of unrelated causes. The 1-, 3-, 5-, and 10-year primary and secondary patency rates were 93% and 96%, 85% and 90%, 78% and 87%, and 56% and 87%, respectively. CONCLUSIONS These data suggest that SFAA use to treat PAA is a safe and durable option. A prospective and comparative work is necessary to confirm these results and to determine the interest of this technique as a first-line strategy.
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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: 0.2] [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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Solución del caso 19. Aneurisma gigante de arteria poplítea. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Dorigo W, Pulli R, Alessi Innocenti A, Azas L, Fargion A, Chiti E, Matticari S, Pratesi C. A 33-year experience with surgical management of popliteal artery aneurysms. J Vasc Surg 2015; 62:1176-82. [DOI: 10.1016/j.jvs.2015.06.216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
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Cervin A, Tjärnström J, Ravn H, Acosta S, Hultgren R, Welander M, Björck M. Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden. Eur J Vasc Endovasc Surg 2015; 50:342-50. [DOI: 10.1016/j.ejvs.2015.03.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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17
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Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair. J Vasc Surg 2015; 61:663-9. [DOI: 10.1016/j.jvs.2014.09.069] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022]
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18
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Comparison of popliteal artery aneurysm therapies. J Vasc Surg 2015; 61:655-61. [DOI: 10.1016/j.jvs.2014.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/05/2014] [Indexed: 11/22/2022]
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Wissgott C, Lüdtke CW, Vieweg H, Scheer F, Lichtenberg M, Schlöricke E, Andresen R. Endovascular treatment of aneurysms of the popliteal artery by a covered endoprosthesis. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:15-21. [PMID: 25574145 PMCID: PMC4274050 DOI: 10.4137/cmc.s15232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/27/2014] [Accepted: 11/09/2014] [Indexed: 12/04/2022]
Abstract
PURPOSE The current gold standard of popliteal artery aneurysm (PAA) treatment is saphenous vein bypass grafting. The aim of this retrospective single-center study is to investigate the safety and efficacy in the treatment of PAA by an endovascular implanted covered endoprosthesis. MATERIALS AND METHODS Ten patients, mean age 64.6 (range, 52–78) years, with PAA were treated with an expanded Polytetrafluoroethylen (ePTFE)-covered stent graft (Viabahn®, W.L. Gore and Associates Inc, Flagstaff, AZ, USA). In median, 1.4 prostheses were implanted with a median length of 180 mm. Follow-up visits included determination of ankle-brachial index (ABI) and color-coded duplex sonography. RESULTS The technical success rate was 100% (10/10). Clinically, there was an increase in ABI from 0.62 ± 0.17 to 0.91 ± 0.15 postinterventionally and to 0.89 ± 0.16 after an average follow-up of 24.7 months. During the follow-up period, 2 (20%) stent occlusions occurred; both of them were treated with a bypass graft. CONCLUSION The treatment of PAA with covered endoprosthesis is a safe and effective alternative to open surgical therapy, where open surgical therapy is contraindicated or patient refused open surgery.
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Affiliation(s)
- Christian Wissgott
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Germany
| | - Christopher W Lüdtke
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Germany
| | - Hendryk Vieweg
- Department of Radiology and Neuroradiology, Asklepios Klinik Nord-Heidberg, Hamburg, Germany
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Germany
| | | | - Erik Schlöricke
- Institute of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Germany
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Hurks R, Kropman RH, Pennekamp CW, Hoefer IE, de Vries JPP, Pasterkamp G, Vink A, Moll FL. Popliteal artery aneurysms differ from abdominal aortic aneurysms in cellular topography and inflammatory markers. J Vasc Surg 2014; 60:1514-9. [DOI: 10.1016/j.jvs.2014.08.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
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Abstract
BACKGROUND Popliteal artery aneurysm (PAA) is a focal dilatation and weakening of the popliteal artery. If left untreated, the aneurysm may thrombose, rupture or the clot within the aneurysm may embolise causing severe morbidity. PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. The success of the procedure is gauged by the ability of the graft to stay patent over an extended duration. While surgical treatment is usually preferred in an emergency, the evidence on first line treatment in a non-emergency setting is unclear. OBJECTIVES To assess the effectiveness of an endovascular stent graft versus conventional open surgery for the treatment of asymptomatic popliteal artery aneurysms (PAA) on primary and assisted patency rates, hospital stay, length of the procedure and local complications. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched their Specialised Register (last searched June 2014) and CENTRAL (2014, Issue 5). Clinical trials databases were searched for any ongoing or unpublished studies. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing endovascular stent grafting versus conventional open surgical repair in patients undergoing unilateral or bilateral prophylactic repair of asymptomatic PAAs were included. DATA COLLECTION AND ANALYSIS Data were collected on primary and secondary patency rates (primary endpoints) as well as operating time, the length of hospital stay, limb salvage and local wound complications (secondary endpoints). MAIN RESULTS A single RCT was identified that conformed to the inclusion criteria. There was a low risk of selection bias and detection bias. However, the risks of performance bias, attrition bias and reporting bias were unclear from the study. Despite being an RCT, the level of evidence was downgraded to moderate due to the small sample size, resulting in wide confidence intervals (CIs); only 30 PAAs were randomised over a period of five years (15 PAAs each in the groups receiving endovascular stent graft and undergoing conventional open surgery). The primary patency rate at one year was 100% in the surgery group and 93.3% in the endovascular group (P = 0.49). However, the assisted patency rate at one year was similar in both groups (100% patency). There was no clear evidence of a difference between the two groups in the primary or secondary patency rates at four years (13 grafts were patent from 15 PAA treatments in each group). However, the effects were imprecise and compatible with the benefit of either endovascular stent graft or surgery or no difference. Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) -3.40 days, 95% CI -4.42 to -2.38; P < 0.001). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD -119.20 minutes, 95% CI -137.71 to -102.09; P < 0.001). Limb salvage was 100% in both groups. Data on local wound complications were not published in the trial report. AUTHORS' CONCLUSIONS Due to the limitations of the current evidence from one small underpowered study, we are unable to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs. A larger ongoing multicentre RCT should provide more information in the future. However, it seems reasonable to suggest that endovascular repair should be considered as a viable alternative to open repair of PAA on a case by case basis.
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Affiliation(s)
- Dhiraj Joshi
- Department of Clinical Radiology, Royal Sussex County Hospital, Eastern Road, Brighton, UK, BN2 5BE
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Long-term Outcomes and Sac Volume Shrinkage after Endovascular Popliteal Artery Aneurysm Repair. Eur J Vasc Endovasc Surg 2014; 48:161-8. [DOI: 10.1016/j.ejvs.2014.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 04/15/2014] [Indexed: 11/21/2022]
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Hogendoorn W, Schlösser FJ, Moll FL, Muhs BE, Hunink MM, Sumpio BE. Decision analysis model of open repair versus endovascular treatment in patients with asymptomatic popliteal artery aneurysms. J Vasc Surg 2014; 59:651-62. [DOI: 10.1016/j.jvs.2013.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/06/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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Editor's Choice: Contemporary Treatment of Popliteal Artery Aneurysm in Eight Countries: A Report from the Vascunet Collaboration of Registries. Eur J Vasc Endovasc Surg 2014; 47:164-71. [DOI: 10.1016/j.ejvs.2013.10.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
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Pulli R, Dorigo W, Castelli P, Dorrucci V, Ferilli F, De Blasis G, Monaca V, Vecchiati E, Benincasa A, Pratesi C. A Multicentric Experience with Open Surgical Repair and Endovascular Exclusion of Popliteal Artery Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:357-63. [DOI: 10.1016/j.ejvs.2013.01.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
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Tsilimparis N, Dayama A, Ricotta JJ. Open and Endovascular Repair of Popliteal Artery Aneurysms: Tabular Review of the Literature. Ann Vasc Surg 2013; 27:259-65. [DOI: 10.1016/j.avsg.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/23/2012] [Indexed: 11/17/2022]
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One-stage hybrid repair of multiple degenerative aneurysms. Case Rep Vasc Med 2012; 2012:432127. [PMID: 23050192 PMCID: PMC3461618 DOI: 10.1155/2012/432127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/31/2012] [Indexed: 11/30/2022] Open
Abstract
The development of multiple aneurysms in different segments of the arterial tree requiring treatment is a challenge for the vascular surgeon as their management often demands more than one surgical procedure. We report a case of a 71-year-old male suffering from multiple aneurysms in four different segments of the arterial tree in combination with disabling claudication of his left leg. The patient was managed in a single session with a combination of classic open surgical and endovascular techniques in order to treat his aneurysms and revascularize his leg. This case illustrates the prospect to combine classic open surgical and endovascular techniques for the optimal management of multileveled arterial pathology. Combined therapy simplifies management and allows the one-stage treatment of these patients, while minimizing the overall operative risk.
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Ohrlander T, Merlo J, Ohlsson H, Sonesson B, Acosta S. Socioeconomic position, comorbidity, and mortality in aortic aneurysms: a 13-year prospective cohort study. Ann Vasc Surg 2011; 26:312-21. [PMID: 22079461 DOI: 10.1016/j.avsg.2011.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 01/31/2011] [Accepted: 08/03/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate factors associated with incidence and 3-year all-cause mortality in patients with aortic aneurysm (AA). The design is sex and age-stratified (60-79 and 80-90 years) prospective cohort. By using the population register, we constituted a cohort of all men and women born between 1900 and 1930 and living in Scania by 1991, and followed them for 13 years. Identification of AA was based on hospital discharge diagnosis obtained from the Swedish Patient Register or from the information on death certificates from the Cause of Death Register. METHODS We applied stepwise Cox regression and investigated both AA incidence (1991-2003) as well as 3-year survival after the first hospitalization for AA. RESULTS We found an inverse relation between AA incidence and previous hospitalization by diabetes mellitus in women (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.19-0.88) and in men (HR: 0.38; 95% CI: 0.24-0.61) aged 60-79 years. Three-year all-cause mortality after diagnosis of AA was 58.6% in women, 50.2% in men, 72.9% in octogenarians, and 43.7% for nonoctogenarians. Low income, chronic respiratory diseases, cerebrovascular diseases, dementia, systemic connective tissue disorders, renal failure, and malignant neoplasms were independent factors for mortality in 60-79-year-old men with AA. CONCLUSIONS Inferior socioeconomic position is associated with increased 3-year all-cause mortality in 60-79-year-old men with AA.
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Affiliation(s)
- Tomas Ohrlander
- Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden
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Bisdas T, Paraskevas KI, Pichlmaier M, Wilhelmi M, Haverich A, Teebken OE. Dorsal (Posterior) Versus Medial Approach for the Surgical Repair of Popliteal Artery Aneurysms. Angiology 2010; 61:248-52. [DOI: 10.1177/0003319709355802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The surgical approach-of-choice for the management of popliteal artery aneurysms (PAAs) remains controversial. We compared the results of the medial (MA) and dorsal (posterior) surgical approach (DA). Fifty patients (44 males/6 females; median age [range]: 59 [49-84] years) treated for 58 atherosclerotic PAAs were studied (MA: 29 PAAs; DA: 29 PAAs). The 3-year graft patency rates were higher after DA compared with MA (76% vs 52%, respectively), but the difference was not significant (P = .056). There were no differences between the 2 approaches in amputation, restenosis, reoperation, and wound infection rates. Dorsal approach and the MA may be alternative approaches with similar long-term results. Due to the controversial results reported so far, a meta-analysis may be necessary to establish the surgical approach-of-choice. Future studies should take into account additional factors, other than the surgical technique, when assessing outcome (eg, preoperative statin use, age, and emergency vs routine surgery).
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Affiliation(s)
- Theodosios Bisdas
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Maximilian Pichlmaier
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Matthias Wilhelmi
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Omke Enno Teebken
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Open versus endovascular repair of popliteal artery aneurysms. J Vasc Surg 2010; 51:271-6. [PMID: 20117505 DOI: 10.1016/j.jvs.2009.09.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
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31
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Johnson ON, Sidawy AN, Scanlon JM, Walcott R, Arora S, Macsata RA, Amdur RL, Henderson WG. Impact of obesity on outcomes after open surgical and endovascular abdominal aortic aneurysm repair. J Am Coll Surg 2009; 210:166-77. [PMID: 20113936 DOI: 10.1016/j.jamcollsurg.2009.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 10/16/2009] [Accepted: 10/21/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study examined impact of obesity on outcomes after abdominal aortic aneurysm repair. STUDY DESIGN Data were obtained from the Veterans Affairs National Surgical Quality Improvement Program. Body mass index (BMI) was categorized according to National Institutes of Health guidelines. Multivariate regression adjusted for 40 other risk factors to analyze trends in complications and death within 30 days. RESULTS We identified 2,201 patients undergoing 1,185 open and 1,016 endovascular aneurysm repairs (EVAR) for abdominal aortic aneurysms from January 2004 through December 2005. BMI distribution was identical in both groups and reflected national population statistics: approximately 30% were normal (BMI 18.5 to 24.9), 40% were overweight (25.0 to 29.9), and 30% were obese class I (30.0 to 34.9), II (35.0 to 39.9), or III (>/=40.0). After open repair, obesity of any class was independently predictive of wound complications (adjusted odds ratio = 2.4; 95% CI, 1.5 to 5.3; p = 0.002). Class III obesity was also an independent predictor or renal complications (adjusted odds rato = 6.3; 95% CI, 2.2 to 18.0; p < 0.0001) and cardiac complications (adjusted odds ratio = 4.5; 95% CI, 1.1 to 22.9; p = 0.045. After EVAR, obesity (any class) was predictive of wound complications (adjusted odds ratio = 3.1; 95% CI, 1.1 to 8.1; p = 0.026), but not predictive of other complications or death. Between the two types of operation, there were fewer complications and deaths after EVAR compared with open repair across all BMI categories, but outcomes were most disparate among the obese. CONCLUSIONS Obesity is an independent risk factor that surgeons should consider during patient selection and operative planning for abdominal aortic aneurysm repair. Obese patients appear to particularly benefit from successful EVAR over open repair, but if open repair is required, special attention should be paid to cardiac risk, perioperative renal protection, and aggresive wound infection prevention measures.
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Affiliation(s)
- Owen N Johnson
- Surgical Services, Veterans Affairs Medical Center, Washington, DC
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32
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Itani KM. Fifteen years of the National Surgical Quality Improvement Program in review. Am J Surg 2009; 198:S9-S18. [DOI: 10.1016/j.amjsurg.2009.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 08/04/2009] [Indexed: 12/22/2022]
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