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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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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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Napier J, Batool F, Sundararaghavan VL, Jackson MW, Vely A, Khorfan R, Hance L, Jones DJ, Heidenreich MJ, Aziz A. Use of Endoscopic Vein Harvest Yields Improved Outcomes in Popliteal Artery Aneurysm Repair. Ann Vasc Surg 2023:S0890-5096(23)00063-8. [PMID: 36758938 DOI: 10.1016/j.avsg.2023.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is growing literature showing that endoscopic vein harvest (EVH) is safe, with excellent patency rates and decreased wound complications when treating infrainguinal occlusive disease. Our institution has performed EVH since 2003 with a dedicated team of providers specializing in endoscopic vein harvest. The purpose of this study was to evaluate major outcomes of EVH as an adjunct to standard, open operative repair of popliteal artery aneurysms. METHODS We performed a 12-year retrospective single-institution chart review from January 2005 to December 2017, identifying all patients undergoing popliteal artery aneurysm repair with EVH. Primary outcomes were procedural technical success, operative time, wound complication, major morbidity, and freedom from amputation. RESULTS A total 37 limbs (in 31 patients) received EVH popliteal artery aneurysm repair at an average age of 65.2 ± 10 years; 65% of the patients presented without symptoms or with claudication and 35% with rest pain or tissue loss. Coexisting aneurysm was present in 68% of patients: 49% had contralateral popliteal artery aneurysms and 19% had concurrent aortic aneurysms. Of 37 limbs, 33 (89%) were treated through a medial approach with aneurysm ligation, and 4 patients (11%) were treated through a posterior approach. The average vein size was 4.4 ± 1.1 mm, with 86% harvested by the ipsilateral great saphenous vein. Average operative time was 3.89 ± 0.82 hr, with a median hospitalization of 2 days and a median of 1 day of intravenous narcotics use. Only 2 patients (5.4%) had Szilagyi class-2 surgical site infections remedied with debridement and antibiotics. Kaplan-Meier data showed a 5-year primary patency of 82.3% and primary-assisted patency of 88.2%. Additionally, 30-day primary patency was 89.2% and primary-assisted patency of 97.3%. CONCLUSIONS EVH for popliteal aneurysmal disease provides a safe and efficacious means of popliteal artery aneurysm repair with shorter hospitalization, lower wound complication rates, and excellent long-term patency compared to standard open technique.
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Affiliation(s)
- Jarred Napier
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Farwa Batool
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | | | - Miles W Jackson
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Aela Vely
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Rhami Khorfan
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - LaWaun Hance
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Diane J Jones
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Michael J Heidenreich
- Department of Surgery, Section of Vascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Abdulhameed Aziz
- Department of Surgery, Section of Vascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI.
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4
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Violari E, Payomo A, Schiro BJ, Powell A, Gandhi RT, Pena CS. Endovascular Treatment of Infra-Inguinal Peripheral Arterial Disease (PAD): Update on Stent Technology. Tech Vasc Interv Radiol 2022; 25:100840. [DOI: 10.1016/j.tvir.2022.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Outcomes of popliteal stent-graft placement at the artery hinge point for popliteal artery aneurysm. Ann Vasc Surg 2022; 84:270-278. [PMID: 35108552 DOI: 10.1016/j.avsg.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES to assess whether stent-grafts crossing the hinge point (HP) in the popliteal artery are associated with increased complications and decreased patency rates, after endovascular treatment of the popliteal artery aneurysm. METHODS This was a single-center, case-control study. Patients were allocated to either the HP group (subjects with stent-grafts crossing the HP) or the control group (subjects with stent-grafts above and/or below the HP) based on stent-graft location in the femoropopliteal artery. HP was defined as the main curve in the popliteal artery in the most acute angle toward the femur that appeared during knee flexion, which was identified by reviewing post-operative angiograms. Independent, blinded reviews were performed for all imaging data. Graft evaluation by CTA or duplex ultrasound was performed at 1, 3, 6, and 12 months and annually thereafter. Outcomes measured included: stent-graft patency, stent-graft fracture, other stent-related complications, and major adverse events, including reintervention, death, amputation, stroke, and myocardial infarction. RESULTS A total of 44 limbs treated with placement of heparin-bonded Viabahn endoprostheses were included in this study. Twenty and Twenty Four patients were allocated to the HP group and the control group, respectively. Primary patency rates of the HP group at 1, 2, 3, and 5 years were 84.1±8.4%, 84.1±8.4%, 84.1±8.4%, and 72.1±13.3%, respectively. The primary patency rates of the control group were 87.0±7.0%, 82.4±8.0%, 82.4±8.0%, and 82.4±8.0%, respectively. There was no significant difference between the two groups (P=0.81). No reintervention was performed in the control group. In the HP group, 5 limbs (25.0%) developed endoleak, 3 (15.0%) developed thrombosis, and one (5.0%) developed a stent fracture followed by thrombosis. Thrombosis occurred in 2 limbs (8.3%) of the control group, and stent-graft migration was observed in another 2 cases (8.3%). Neither group demonstrated stent-graft infection or acute popliteal artery embolism. Overall, incidence of stent-related complications were significantly higher in the HP group (P=0.04). Event-free survival rates of the HP group at 1, 2, 3, and 5 years were 75.0±9.7%, 69.6±10.4%, 61.9±11.8%, and 29.0±12.8%, respectively. Corresponding rates in the control group were 79.2±8.3%, 79.2±8.3%, 79.2±8.3%, and 79.2±8.3%, respectively. The difference was not statistically significant between the two groups (P=0.20) CONCLUSIONS: crossing the HP with femoropopliteal artery stent-grafts increased the risk of stent-related complications and reinterventions but did not decrease stent patency or event-free survival.
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Jung G, Leinweber ME, Karl T, Geisbüsch P, Balzer K, Schmandra T, Dietrich T, Derwich W, Gray D, Schmitz-Rixen T. Real-world data of popliteal artery aneurysm treatment. Analysis of the POPART registry. J Vasc Surg 2022; 75:1707-1717.e2. [PMID: 35066058 DOI: 10.1016/j.jvs.2021.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Popliteal artery aneurysm (PAA) is a rare disease with a prevalence of 0.1-1%. Within the last years, endovascular repair of PAA (ER) has been performed more frequently despite the lack of high-level evidence compared to open surgery (OR). In 2014, the POPART registry was initiated to validate current treatment options in PAA repair.
METHOD: POPART is a multinational multicenter registry for peri- and postoperative outcome of endovascular and open PAA repair. Data sets are recorded by the online survey tool "SurveyMonkey®". Regular monitoring and plausibility checks of the data sets are performed to ensure reliability. The aim of this study is to present results of the POPART registry, with data of 41 centers.
RESULTS: From June 2014 to August 2019, a total of 794 cases were recorded in the PAA registry. OR was performed in 662 patients and ER in 106 patients; 23 Patients were treated conservatively. Four of the 106 patients with primary ER underwent conversion to OR. ER patients were significantly older (ER x˜= 71 vs. OR x˜= 67 (p<0.05). There were no other significant differences in demographics or comorbidities and aneurysm morphology between the two groups. 50.3% patients in the OR group were symptomatic; in the ER group 29.2% (p<0.05). Emergency treatment for acute ischemia, critical ischemia or rupture was necessary in 149 patients (22.5%) in the OR group vs. 11 patients (10.3%) in the ER group.
Most frequent complications after surgery were impaired wound healing (OR n=47, 7.1%; ER n=3, 2.8%, p>0.05) and major bleeding (OR n=26, 3.9%; ER n=3, 2.8%, p>0.05). In-hospital length of stay (= 10d [3-65] OR vs. x˜=7d [1-73] ER) was significantly higher in the OR group. Overall patency was 83.2% vs. 44.7% (OR/ER, p<0.005) after 12 months and 74.2% vs. 29.1% (OR/ER, p<0.005) after 24 months. There was a significantly poorer outcome for prosthetic graft compared to autologous vein in the OR group (71.4% vs. 88.1% 12-month primary patency).
CONCLUSION:
In order to evaluate new treatment techniques such as endovascular repair (ER) for PAA, real world data is of essential importance. This analysis of the first results for the POPART registry shows good perioperative results for endovascular treatment of PAA in asymptomatic patients with good outflow vessels. The perioperative complication rate is low and the postoperative hospital stay is shorter than after OR. However, the patency rates after 12 and 24 months are low in the ER group compared to patients treated with open repair. More follow-up data is required for further interpretation; the completion of the data sets in the registry is ongoing.
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Affiliation(s)
- Georg Jung
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany.
| | - Maria-Elisabeth Leinweber
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart- Katharinenhospital, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St.-Marien-Hospital, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular and Endovascular Surgery, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
| | - Tanja Dietrich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Daphne Gray
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany; German Institute of Vascular Public Health Research, Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG), Berlin, Germany
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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: 0] [Impact Index Per Article: 0] [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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Zaghloul MS, Andraska EA, Leake A, Chaer R, Avgerinos ED, Hager ES, Makaroun MS, Eslami MH. Poor runoff and distal coverage below the knee are associated with poor long-term outcomes following endovascular popliteal aneurysm repair. J Vasc Surg 2021; 74:153-160. [PMID: 33347999 DOI: 10.1016/j.jvs.2020.12.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Reports of good short-term outcomes for endovascular repair of popliteal artery aneurysms have led to an increased use of the technique. However, data are lacking on long-term limb-related outcomes and factors associated with the failure of endovascular repair. METHODS All patients who underwent endovascular popliteal aneurysm repair (EPAR) at a single institution from January 2006 to December 2018 were included in the study. Demographics, indications, anatomic and operative details, and outcomes were reviewed. Long-term patency, major adverse limb event-free survival (MALE-FS) and graft loss/occlusion were analyzed with multivariable cox regression analysis and Kaplan-Meier curves. RESULTS We included 117 limbs from 101 patients with a mean follow-up of 55.6 months (range, 0.43-158 months). The average age was 73 ± 9.3 years. Thirty-two patients (29.1%) were symptomatic (claudication, rest pain, tissue loss, or rupture). The stent grafts crossed the knee joint in 91.4% of cases. In all, 36.8% of procedures used one stent graft, 41.0% used two stent grafts, and 22.2% of procedures used more than two stent grafts. The median arterial length covered was 100 mm, with an average length of stent overlap of 25 mm. Tapered configurations were used in 43.8% of cases. The majority of limbs (62.8%) had a three-vessel runoff, 20.2% had a two-vessel runoff, and 17% has a one-vessel runoff. The Kaplan-Meier estimates of graft occlusion at 1 and 3 years were 6.3% and 16.2%, respectively. The 1- and 3-year primary patency rates were 88.2% and 72.6%, and the 1- and 3-year major adverse limb event-free survival (MALE-FS) rates were 82% and 57.4%. The 1- and 3-year survival rates were 92.9% and 76.2%, respectively. On multivariable Cox regression, aneurysm size, one-vessel runoff, and coverage below the knee were associated with a lower 3-year MALE-FS. Coverage below the knee was also associated with a lower 3-year MALE-FS. Other anatomic or technical details were not associated with limb-related events or patency. CONCLUSIONS This study is the largest single center analysis to describe the predictors of poor outcomes after EPAR. EPAR is a safe and effective way to treat popliteal artery aneurysms. Factors associated with poor MALE-FS after EPAR include single-vessel tibial runoff and coverage below the knee.
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Affiliation(s)
- Mohamed S Zaghloul
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Elizabeth A Andraska
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Andrew Leake
- Vascular Surgery Associates of Richmond, PC, Richmond, Va
| | - Rabih Chaer
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Efthymios D Avgerinos
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Eric S Hager
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Michel S Makaroun
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa
| | - Mohammad H Eslami
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pa.
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Nakashima M, Kobayashi M. Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms. Vasc Specialist Int 2021; 37:37-40. [PMID: 33795552 PMCID: PMC8021490 DOI: 10.5758/vsi.200077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. We have presented a case of PAA in an 81-year-old woman complaining of tingling sensations in her leg. Computed tomography revealed a large 10-cm sized PAA. Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein.
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Affiliation(s)
- Masaya Nakashima
- Department of Vascular Surgery, Tokoname Municipal Hospital, Tokoname, Japan
| | - Masayoshi Kobayashi
- Department of Cardiovascular surgery, Fujita Health University Graduate School of Medicine, Toyoake, Japan
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10
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Lauricella A, Gennai S, Covic T, Leone N, Migliari M, Andreoli F, Silingardi R. Outcome of Endovascular Repair of Popliteal Artery Aneurysms using the Supera Stent. J Vasc Interv Radiol 2021; 32:173-180. [PMID: 33485505 DOI: 10.1016/j.jvir.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate the efficacy of endovascular repair of popliteal artery aneurysms (PAAs) with a wire-interwoven nitinol stent. MATERIALS AND METHODS This is a prospective, descriptive, and analytical study. From January 2016 to December 2018, 28 consecutive patients (29 lower limbs) were treated for a PAA with the deployment of the Supera stent (Abbott Vascular, Illinois). Twenty-three (79.3%) PAAs were asymptomatic; 6 (20.7%) presented with symptoms. The mean diameter and length of the aneurysm were 26.8 mm (20-40 mm) and 47.1 mm (23-145 mm) respectively. The primary endpoint was the prevention of embolic symptoms. The secondary endpoints were aneurysm exclusion, aneurysm diameter decrease, freedom from reintervention, and preservation of preoperative runoff vessels. RESULTS Technical success was 100%, with a median of 2.4 run-off vessels at completion angiography, without any loss of run-off vessels. A double Supera stent was deployed in 10 cases. At completion angiography, a median of 2.4 runoff vessels were present, without any loss of runoff vessels. The mean follow-up time was 24.3 (12-35) months. Primary endpoints were reached in 100% of the cases and vessels run off was preserved in all cases. In 2 PAAs, complete sac thrombosis was witnessed at 6-month follow-up, while at 12-month follow-up, it was seen in 10 of 29 (34.4%) limbs. In all the other cases the diameter of the aneurysm remained stable, with a freedom from sac enlargement of 100%. No fractures or stent thromboses were detected. CONCLUSIONS For endovascular repair of PAAs, the use of a thick interwoven-wire stent, that could work like a multilayer flow modulator showed encouraging mid-term results with no cases of stent fracture, occlusion or aneurysm increase.
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Affiliation(s)
- Antonio Lauricella
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
| | - Stefano Gennai
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
| | - Tea Covic
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy.
| | - Nicola Leone
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
| | - Mattia Migliari
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
| | - Francesco Andreoli
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
| | - Roberto Silingardi
- Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy
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Sousa RS, Oliveira-Pinto J, Mansilha A. Endovascular versus open repair for popliteal aneurysm: a review on limb salvage and reintervention rates. INT ANGIOL 2020; 39:381-389. [DOI: 10.23736/s0392-9590.20.04387-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Schwarze V, Marschner C, de Figueiredo GN, Rübenthaler J, Clevert DA. Contrast-enhanced ultrasound (CEUS) in the diagnostic evaluation of popliteal artery aneurysms, a single-center study. Clin Hemorheol Microcirc 2020; 76:191-197. [PMID: 32925018 DOI: 10.3233/ch-209214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Popliteal artery aneurysms (PAA) are the most common peripheral artery aneurysms. Most common cause is arteriosclerosis. Acute thromboembolic limb ischemia and rupture of the PAA depict severe complications. Diagnostic tools for identifying PAAs are (Doppler) ultrasound, CT/MR angiography and DSA. PURPOSE The aim of the present retrospective single-center study is to assess the application and safety of CEUS for assessing untreated and treated PAAs. MATERIALS AND METHODS 13 patients were included in this study on whom CEUS was performed between 2007-2016. CEUS examinations were performed and interpreted by an experienced single radiologist (EFSUMB Level 3). RESULTS CEUS allowed for the detection of PAAs in all cases. CEUS allowed for detection of partial thrombosis of PAA in 7/8 of untreated patients, proper exclusion of PAA upon femoro-popliteal bypass in 3 patients, incomplete exclusion of PAA upon femoro-popliteal bypass in 1 patient and ruling out of in-stent stenosis in 1 patient. CONCLUSION CEUS is a useful and safe tool for in real-time evaluation of PAAs in the pre-/post-treatment status. In addition to conventional (Doppler) ultrasound and as an alternative tool to more elaborate imaging modalities, CEUS might be integrated in the future diagnostic work-up and follow-up of PAA patients.
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Affiliation(s)
- V Schwarze
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - C Marschner
- Department of Radiology, University Hospital LMU, Munich, Germany
| | | | - J Rübenthaler
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - D-A Clevert
- Department of Radiology, University Hospital LMU, Munich, Germany
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Wrede A, Acosta S. Outcome of Open and Endovascular Repair in Patients with Acute Limb Ischemia Due to Popliteal Artery Aneurysm. Ann Vasc Surg 2020; 67:376-387. [DOI: 10.1016/j.avsg.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 11/26/2022]
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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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Tian Y, Yuan B, Huang Z, Zhang N. A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis. Vasc Endovascular Surg 2020; 54:355-361. [PMID: 32122277 DOI: 10.1177/1538574420908091] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Traditionally, popliteal artery aneurysms (PPAs) were treated via open repair (OR). However, more recently endovascular repair (EVR) approaches have become more common for the treatment of PPAs. The present meta-analysis therefore sought to conduct an up-to-date review of studies comparing the relative safety and efficacy of these 2 repair strategies. To that end, patient outcomes including primary patency, operating time, hospital stay duration, and re-intervention, amputation, and graft occlusion within 30 days were compared for these OR and EVR approaches. METHODS Studies in which OR and EVR were compared as treatments for PPAs were identified through systematic searching of the PubMed and Embase databases. Any studies either analyzing only one of these treatments in isolation or analyzing <5 patients were not included in this analysis. For all relevant studies, patient demographic information and outcome details were compiled. Risk of bias was analyzed using a modified Newcastle-Ottawa Scale. The odds ratios, mean differences, and hazard ratios (HRs) for patient outcomes were estimated using a random-effects model. RESULTS In total, we identified 17 relevant studies including a single randomized controlled trial and 16 retrospective cohort studies, incorporating 6887 total cases (1662 EVR and 5225 OR). The quality of evidence for all measured outcomes was deemed to be very low or low according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Rates of primary patency were found to be significantly higher for patients treated via OR relative to those treated via EVR (HR = 1.60; 95% confidence interval [CI]: 1.12-2.30; P = .03). Operative and hospitalization durations, in contrast, were significantly lower for patients treated via EVR. Patients treated via EVR also experienced significantly higher rates of graft thrombosis and reintervention within 30 days relative to patients treated via OR. However, no significant differences were observed between treatments with respect to rates of patient amputation (OR = 1.01; 95% CI: 0.55-1.85; P = .98). CONCLUSIONS The available data suggest that PPA repair via EVR is a safe alternative to OR, but that short-term graft thrombosis and reintervention rates are significantly greater for the former approach. Moreover, few studies to date have compared these techniques and those that were largely retrospective in nature with relatively low-quality evidence, making it difficult to make definitive statements regarding the relative safety and efficacy of these 2 repair strategies. Additional population-based large-scale studies are therefore essential in order to conduct a robust evaluation of the safety and utility of EVR as an alternative to OR for PPA repair.
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Affiliation(s)
- Yu Tian
- Department of Vascular Surgery, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Biao Yuan
- Department of Vascular Surgery, Beijing Chao Yang Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Zhiyong Huang
- Department of Vascular Surgery, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Ning Zhang
- Department of Vascular Surgery, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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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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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: 3.0] [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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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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Grimm JJ, Wise MM, Meissner MH, Nicholls SC. The Incidence of Popliteal Artery Aneurysms in Patients with Abdominal Aortic Aneurysms. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670703100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose We sought to evaluate the incidence of popliteal artery aneurysms (PAAs) in patients who have a diagnosis of abdominal aortic aneurysm (AAA). Methods It has been previously documented that patients with AAA have a greater incidence of PAA. During the past 11 years, 163 patients presented to the Vascular Laboratory at Harborview Medical Center with an AAA. Seventy-one (44%) of these patients had popliteal arteries evaluated using duplex ultrasound (Advanced Technology Laboratory 3000, 5000, 9000). The popliteal artery was measured in the anteroposterior and transverse diameters. A PAA was defined as an artery larger than 1.5 cm and/or an ectatic artery with thrombus present. Results Fourteen patients had a PAA; six patients (43%) had PAA bilaterally, for a total of 20 aneurysms. Nineteen (95%) aneurysms had thrombus present. Various interventional treatments were used: five limbs (25%) received an arterial bypass graft, two (10%) underwent amputation, and two (10%) received thrombolytic therapy Conclusions There is a high incidence of PAA in patients with AAA (19.7% in this series). Patients with a diagnosis of AAA should be screened for PAA and considered for elective repair to prevent the high rate of complications associated with these lesions.
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Affiliation(s)
- Jodi J. Grimm
- Vascular Laboratory, Harborview Medical Center, Seattle, Washington
| | - Matthew M. Wise
- Vascular Laboratory, Harborview Medical Center, Seattle, Washington
| | - Mark H. Meissner
- Department of Surgery, University of Washington, Seattle, Washington
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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: 1.8] [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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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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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: 53] [Impact Index Per Article: 7.6] [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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Rajasinghe HA, Tzilinis A, Keller T, Schafer J, Urrea S. Endovascular Exclusion of Popliteal Artery Aneurysms With Expanded Polytetrafluoroethylene Stent-Grafts: Early Results. Vasc Endovascular Surg 2016; 40:460-6. [PMID: 17202092 DOI: 10.1177/1538574406294366] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is increasing interest in using endovascular methods instead of surgical reconstruction to treat popliteal artery aneurysms. Exclusive use of the Viabahn stentgraft, a nitinol stent covered with expanded polytetrafluoroethylene, was assessed in the treatment of patients who presented with popliteal artery aneurysms in the absence of acute limb ischemia. Technical success, endoleaks, graft patency, freedom from amputation, and aneurysm sac flow and size changes were assessed by duplex ultrasound. From June 2004 to March 2006, 16 men (mean age, 76 years; range, 65-83) underwent endovascular exclusion of 23 popliteal artery aneurysms (mean diameter, 2.5 cm; range, 1.3-6.7 cm). Nine lesions had partial thrombus on preprocedural duplex imaging. Nineteen of the 23 limbs treated had at least 2-vessel tibial artery runoff. Procedures were performed under local anesthesia using ipsilateral percutaneous antegrade arterial access. All patients received 75 mg/day of clopidogrel afterward. Follow-up assessments included direct clinical examinations and duplex ultrasonography performed 1, 3, 6, and 12 months after the procedure. Primary patency and amputation-free survival were calculated using Kaplan-Meier analysis. Complete aneurysm exclusion (technical success) was achieved in all cases. During the mean follow-up of 7 months (range, 1-21 months), 22 of 23 treated limbs remained asymptomatic. One stent-graft thrombosis occurred 6 months after the procedure and was successfully treated with percutaneous mechanical thrombectomy, balloon angioplasty of a stent-graft stenosis, and insertion of an uncovered nitinol stent. No popliteal artery aneurysm sac size enlargements or endoleaks were detected. At 12 months, the treated limb mean anklebrachial index was 1.0 (range, 0.82-1.31) and the primary and secondary patency rates were 93% and 100%, respectively. Early results with Viabahn endovascular stent-graft exclusion of asymptomatic popliteal artery aneurysms are promising. Patient selection for endovascular repair depends on suitable popliteal artery anatomy, extent of aneurysmal degeneration, and quality of tibial arterial runoff.
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Affiliation(s)
- Hiranya A Rajasinghe
- Vascular Surgery and Endovascular Intervention, Anchor Health Centers, Naples, FL 34102, USA.
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Heuser RR, Reynolds GT, Papazoglou C, Diethrich EB. Endoluminal Grafting for Percutaneous Aneurysm Exclusion in an Aortocoronary Saphenous Vein Graft: The First Clinical Experience. J Endovasc Ther 2016; 2:81-8. [PMID: 9234122 DOI: 10.1177/152660289500200112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Aneurysms develop only rarely in aortocoronary saphenous vein grafts (SVGs), and the usual treatment is surgical replacement of the diseased segment. However, in patients at appreciable risk for redo surgery, alternative therapies are desirable. We report the first compassionate use of a percutaneously delivered endoluminal graft (ELG) for internal exclusion of an SVG aneurysm. Methods: A 47-year-old male with two coronary bypass procedures and SVG angioplasty presented with an 8-mm diameter aneurysm lying between 80% and 70% stenotic lesions in an SVG to the obtuse marginal branch. The risks of a third bypass operation were considerable, so the decision was made to attempt internal exclusion of the SVG aneurysm. Results: An ELG composed of 2.0-mm diameter unexpanded PTFE graft material with Palmaz stents for fixation was delivered with a low-profile system, but a second ELG was necessary for complete exclusion of the aneurysmal sac. Both ELGs were dilated after initial deployment. The patient was discharged after 9 days without sequelae, and he remains asymptomatic with arteriographically documented ELG patency 5 months after treatment. Conclusions: In this patient with limited therapeutic options, percutaneous aneurysm exclusion in an SVG was effective in restoring a viable blood conduit. It remains to be seen if ELGs have a potential in aortocoronary SVGs.
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Affiliation(s)
- R R Heuser
- Department of Cardiology, Arizona Heart Institute & Foundation, Phoenix 85006, USA
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Dorros G, Joseph G. Closure of a Popliteal Arteriovenous Fistula Using an Autologous Vein-Covered Palmaz Stent. J Endovasc Ther 2016. [DOI: 10.1177/152660289500200210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the use of autologous vein to cover a stainless steel stent designated for repair of a traumatic popliteal arteriovenous (AV) fistula. Methods and Results: Autologous cephalic vein was harvested to cover a Palmaz biliary stent selected to close a traumatic popliteal AV fistula that persisted despite reparative attempts with balloon occlusion and coil embolization. The vein-covered stent was delivered percutaneously and deployed, successfully obliterating the vascular communication. Patency of the popliteal artery was documented arteriographically at 5 months, and symptomatic improvement continues at 10 months. Conclusion: The simplicity of this percutaneous approach and the use of autologous vein to cover endovascular prostheses create the possibility for evaluating this technique in myriad anatomical situations.
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Affiliation(s)
- Gerald Dorros
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
| | - George Joseph
- The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., St. Luke's Medical Center, and the Milwaukee Heart and Vascular Clinic, SC, Milwaukee, Wisconsin, USA
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Kudelko PE, Alfaro-Franco C, Diethrich EB, Krajcer Z. Successful Endoluminal Repair of a Popliteal Artery Aneurysm Using the Wallgraft Endoprosthesis. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe the first application of the Wallgraft endovascular prosthesis to aneurysm exclusion in the popliteal artery. Methods and Results: A 61-year-old man was admitted to our institution with a popliteal artery aneurysm complicated by associated popliteal vein compression, deep venous thrombosis, and pulmonary embolism. The endovascular procedure was performed percutaneously with local anesthesia using a low-profile, covered stent (Wallgraft Endoprosthesis). The aneurysm was successfully excluded from the arterial circulation, and there were no postprocedural complications. Follow-up evaluation with appropriate imaging at 10 months revealed no endoleaks. Conclusions: This initial result indicates that percutaneous deployment of the Wallgraft endoprosthesis, with its smaller diameter and flexible design, may offer significant advantages over currently available devices for repair of popliteal artery aneurysms. This method obviates the need for general anesthesia or surgical exposure, which is particularly beneficial in patients with comorbid illnesses.
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Affiliation(s)
| | | | - Edward B. Diethrich
- Departments of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Arizona Heart Hospital, Phoenix, Arizona, USA
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Puech-Leão P, Kauffman P, Wolosker N, Anacleto AM. Endovascular Grafting of a Popliteal Aneurysm Using the Saphenous Vein. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. Methods and Results: A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. Conclusions: Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.
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Affiliation(s)
- Pedro Puech-Leão
- Department of Surgery, University of São Paulo Faculty of Medicine, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Surgery, University of São Paulo Faculty of Medicine, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Surgery, University of São Paulo Faculty of Medicine, São Paulo, Brazil
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Veith FJ, Marin ML. Endovascular Surgery and its Effect on the Relationship between Vascular Surgery and Radiology. J Endovasc Ther 2016. [DOI: 10.1177/152660289500200101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frank J. Veith
- Division of Vascular Surgery and the Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Michael L. Marin
- Division of Vascular Surgery and the Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
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Krajcer Z, Diethrich EB. Successful Endoluminal Repair of Arterial Aneurysms by Wallstent Prosthesis and PTFE Graft: Preliminary Results with a New Technique. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe a new method of endovascular aneurysm exclusion using a Wallstent-PTFE vascular prosthesis in patients at high risk for surgery. Methods and Results: Two patients with significant comorbidities refused surgery in favor of endoluminal grafting for treatment of aneurysms in the abdominal aorta and popliteal artery, respectively. Both endovascular procedures were performed percutaneously with local anesthesia using a low-profile customized endograft constructed of thin-walled, predicted polytetrafluoroethylene (PTFE) graft mounted on a Wallstent. In both cases, the aneurysm was excluded from the arterial circulation; there were no postprocedural complications. Follow-up evaluation with appropriate imaging at 8 months (popliteal aneurysm) and 2 months (abdominal aneurysm) revealed no endoleaks. Conclusions: Our preliminary results indicate that the Wallstent-PTFE graft, with its smaller diameter and flexible design, offers significant advantages over currently available devices for repair of arterial aneurysms. This method obviates the need for general anesthesia or surgical exposure for arterial repair, which would increase the risk of the procedure in these patients.
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Affiliation(s)
- Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, and St. Luke's Episcopal Hospital, Houston, Texas, USA
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Mousa AY, Beauford RB, Henderson P, Patel P, Faries PL, Flores L, Fogler R. Update on the Diagnosis and Management of Popliteal Aneurysm and Literature Review. Vascular 2016; 14:103-8. [PMID: 16956479 DOI: 10.2310/6670.2006.00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Popliteal artery aneurysms (PAAs) are the most frequent peripheral aneurysm with a significant morbidity if left untreated. Open surgical technique is still considered the gold standard; however the revolution in endovascular repair has proven to be a valid alternative option in selected patients. The role of endovascular treatment in PAA is still considered in its infancy. In addition, the indications for use of endovascular stents as compared to standard open surgery have not yet been fully defined and more studies are warranted to characterize the durability of this technique. This article describes the general principles of the natural history, clinical presentation, and long-term limb salvage and survival outcomes for patients with such aneurysms. It also details the features and results for the devices in current use and highlights the current consensus in the management of PAA.
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Affiliation(s)
- Albeir Y Mousa
- New York Weill Cornell Medical Center, New York, NY, USA.
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Braga AFF, Catto RC, Ribeiro MS, Piccinato CE, Joviliano EE. Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.02715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.
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Nishi M, Zen K, Yamaguchi S, Asada S, Kambayashi D. Popliteal artery aneurysm treated with implantation of a covered stent graft (fluency(®)) reinforced with a nitinol stent (S.M.A.R.T. (®)). Cardiovasc Interv Ther 2015; 31:316-20. [PMID: 26581492 DOI: 10.1007/s12928-015-0360-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
A 60-year-old man was admitted for right knee pain provoked by an enlarging popliteal artery aneurysm (PAA) after endovascular therapy for thromboembolism in the right popliteal artery. The PAA was treated with implantation of a covered stent graft (Fluency(®)); however, acute thromboembolism occurred 6 months after the intervention. Therefore, we implanted a nitinol stent (S.M.A.R.T.(®)) in the proximal part of the covered stent where the major hinge point existed in addition to a stent fracture. No vascular event occurred during 4.5 years of follow-up.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Shinichiro Yamaguchi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Satoshi Asada
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - Daisuke Kambayashi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
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Leake AE, Avgerinos ED, Chaer RA, Singh MJ, Makaroun MS, Marone LK. Contemporary outcomes of open and endovascular popliteal artery aneurysm repair. J Vasc Surg 2015; 63:70-6. [PMID: 26474505 DOI: 10.1016/j.jvs.2015.08.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate contemporary practice and outcomes of open repair (OR) or endovascular repair (ER) for popliteal artery aneurysms (PAAs). METHODS Consecutive patients with PAA treated at one institution from January 2006 to March 2014 were reviewed under an Institutional Review Board-approved protocol. Demographics, indications, anatomic characteristics, and outcomes were collected. Standard statistical methods were used. RESULTS A total of 186 PAAs were repaired in 156 patients (110 ORs, 76 ERs) with a mean age of 71 ± 11 years, and most were male (96%). Mean follow-up was 34.9 ± 28.6 months for OR and 28.3 ± 25.8 months for ER (P = .12). Comorbidities were similar between groups. OR was used in more patients with PAA thrombosis (41.8% vs 5.3%; P < .001), acute ischemia (24.5% vs 9.2%; P = .010), and ischemic rest pain (34.5% vs 6.6%; P < .001). Mean tibial (Society for Vascular Surgery) runoff score was 5.0 for OR vs 3.3 for ER (P = .006). OR was associated with increased 30-day complications (22% vs 2.6%; P < .001) and mean postoperative stay (5.8 vs 1.6 days; P < .001). There was no difference in 30-day mortality (OR, 1.8%; ER, 0%; P = .56) or major amputation rate (OR, 3.7%; ER, 1.3%; P = .65). Primary, primary assisted, and secondary patency rates were similar at 3 years (OR, 79.5%, 83.7%, and 85%; ER, 73.2%, 76.3%, and 83%; P = NS). Among 130 patients presenting electively without acute ischemia or thrombosed PAA (63 ORs and 67 ERs), OR had better 3-year primary patency (88.3% vs 69.8%; P = .030) and primary assisted patency (90.2% vs 73.5%; P = .051) but similar secondary patency (90.2% vs 82%; P = .260). ER thrombosis was noted in 8 of 24 patients treated in 2006-2008 (33%; mean time to failure, 49 months) but in only 4 of 51 patients treated in 2009-2013 (7.8%; mean time to failure, 30 months), suggesting a steep learning curve. CONCLUSIONS ER is a safe and durable option for PAA, with lower complication rates and a shorter length of stay. OR has superior primary patency in patients treated electively but no difference in midterm secondary patency and amputations.
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Affiliation(s)
- Andrew E Leake
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael J Singh
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Luke K Marone
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Speziale F, Sirignano P, Menna D, Capoccia L, Mansour W, Serrao E, Ronchey S, Alberti V, Esposito A, Mangialardi N. Ten Years' Experience in Endovascular Repair of Popliteal Artery Aneurysm Using the Viabahn Endoprosthesis: A Report from Two Italian Vascular Centers. Ann Vasc Surg 2015; 29:941-9. [DOI: 10.1016/j.avsg.2015.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
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Ronchey S, Pecoraro F, Alberti V, Serrao E, Orrico M, Lachat M, Mangialardi N. Popliteal Artery Aneurysm Repair in the Endovascular Era: Fourteen-Years Single Center Experience. Medicine (Baltimore) 2015. [PMID: 26222843 PMCID: PMC4554107 DOI: 10.1097/md.0000000000001130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare outcomes of popliteal artery aneurysm (PAA) repair by endovascular treatment, great saphenous vein (GSV) bypass, and prosthetic bypass.Single center retrospective analysis of patients presenting PAA from 2000 to 2013. Patients were divided into endovascular treatment (group A); GSV bypass (group B); and prosthetic graft bypass (group C). Outcomes were technical success, perioperative mortality, and morbidity. Survival, primary and secondary patency, and freedom from reintervention rate were estimated. Differences in ankle-brachial index (ABI), in-hospital length of stay (InH-Los), red blood cell (RBC) transfusion, and limb loss were reported. Mean follow-up was 49 (median: 35; 1-145; SD 42) months.Sixty-seven patients were included; 25 in group A, 28 in group B, and 14 in group C. PAA was symptomatic in 23 (34%) cases. Technical success was 100%. No perioperative death occurred. Three (4.5%) perioperative complications were reported with no significant difference between groups (P = 0.866). Five-years estimated survival was 78%. Estimated 5-years primary patency for groups A, B, and C was 71%, 81%, and 69%, respectively (P = 0.19). Estimated 5-years secondary patency for groups A, B, and C was 88%, 85%, and 84% (P = 0.85). Estimated 5-years freedom from reintervention for groups A, B, and C was 62%, 84%, and 70%, respectively (P = 0.16). A significant difference between preoperative ABI versus postoperative ABI was observed (P = 0.001). InH-LoS was significantly shorter in group A (P < 0.001). RBC transfusions were required significantly less in group A when compared to group C (P = 0.045). Overall limb salvage was achieved in all but 1 patient.PAA repair has good early and long-term outcomes with different treatment options. Endovascular treatment was not inferior to surgical repair with a reduced InH-LoS and RBC transfusion. It can be successfully employed even in nonelective setting. A randomized controlled trial with long-term follow-up and appropriate patient inclusion criteria is necessary to compare these 3 treatment options.
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Affiliation(s)
- Sonia Ronchey
- From the Department of Vascular Surgery, San Filippo Neri Hospital, Rome (SR, VA, ES, MO, NM); Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Palermo, Italy (FP); and Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland (ML)
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von Stumm M, Teufelsbauer H, Reichenspurner H, Debus ES. Two Decades of Endovascular Repair of Popliteal Artery Aneurysm--A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 50:351-9. [PMID: 26138062 DOI: 10.1016/j.ejvs.2015.04.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND Over the last two decades endovascular repair (EVR) of popliteal artery aneurysms has emerged as a treatment alternative to conventional open surgical repair (OSR). The aim of this review was to evaluate the safety and efficiency of each repair method, comparing the following outcomes after EVR and OSR: (i) primary patency; (ii) operating time; (iii) length of hospital stay; (iv) peri-operative complications; (v) limb salvage; and (vi) patient survival. METHODS The PubMed and Cochrane Central Register of Controlled Trials were searched for publications that compared outcomes after EVR and OSR (last search November 2014). Randomized controlled trials (RCTs), prospective and retrospective observational cohort studies were included. The quality of studies was evaluated using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random effect models were employed to estimate odds ratios (ORs), mean differences, and hazard ratios (HRs). RESULTS One RCT combined with a prospective cohort study and four retrospective cohort studies with an overall total of 652 cases (236 EVR, 416 OSR) were identified. GRADE quality of evidence was low or very low for all outcomes. After a median follow up of 33 months, patients who received EVR showed equal primary patency rates to patients who received OSR (HR 1.46, 95% confidence interval [CI] 0.92-2.33). Lengths of operation and hospitalization were significantly shorter following EVR; rates of 30 day graft thrombosis (OR 3.16, 95% CI 1.31-7.62) and 30 day re-intervention (OR 2.15, 95% CI 1.02-4.55) were significant higher for patients who received EVR compared with those who received OSR. There was no effect on mortality (OR 2.31, 95% CI 0.37-14.49) or limb loss (OR 0.59, 95% CI 0.16-2.15). CONCLUSION EVR of popliteal artery aneurysm showed mid-term results comparable to open surgery and appears to be a safe alternative to OSR. However, the existing empirical evidence base is too fragmentary to draw firm conclusions. Further research and the introduction of population based registries will be needed to allow reliable evaluation of EVR.
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Affiliation(s)
- M von Stumm
- Department of Cardiovascular Surgery, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany.
| | - H Teufelsbauer
- Department of Surgery, Division of Vascular Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - H Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany
| | - E S Debus
- Department of Vascular Medicine, University Heart Center, Martinistr. 52, 20246 Hamburg, Germany
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Moraes AO, Nabeshima RY, Rezende FF, Viotto EF, Bogdan CR. Case report: rupture of popliteal artery aneurysm. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An 83-year-old female patient with a history of prior endovascular treatment to repair an abdominal aortic aneurysm presented with intense pain and edema in the left leg, with hyperemia and localized temperature increase. Doppler ultrasonography revealed a voluminous aneurysm of the popliteal artery with a contained rupture, and hematoma involving the popliteal fossa and the medial and anterior surfaces of the knee causing compression of the popliteal vein. Endovascular repair was accomplished with covered stents and the rupture was confirmed. during the procedure The aneurysm was excluded and the signs and symptoms it had caused resolved completely, but during the postoperative period the patient developed sepsis of pulmonary origin and died.
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Treatment of popliteal artery aneurysms by means of cryopreserved homograft. Ann Vasc Surg 2015; 29:1090-6. [PMID: 26001618 DOI: 10.1016/j.avsg.2015.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Autologous saphenous vein is considered the gold standard conduit in the femoral-popliteal revascularization for popliteal artery aneurysms (PAAs). In several cases, it may be absent or unsuitable for length or diameter and so it may be considered unfit for a conduit. In such patients, a synthetic graft or the endovascular correction can be useful, but results are controversial. In this retrospective case series, we have analyzed the safety and efficacy of the cryopreserved homograft (CHg) as a conduit in the PAA revascularization. METHODS In the period between January 2005 and December 2013, 54 PAAs have been treated with an arterial CHg. Indications to surgery were asymptomatic aneurysm with >25-mm diameter in 30 cases (55.6%), ischemic symptoms in 20 (37%), and compressive symptoms in 4 (7.4%). An urgent treatment was performed in 8 cases (14.8%) for severe ischemic symptoms. All cases have been operated by the same vascular team: a posterior surgical approach was preferred whenever possible (33 cases, 61.1%). All patients received a clinical and radiologic follow-up, and all data were collected in a specific database. A >10-mm diameter increase of the conduit was considered significant for an aneurysmatic degeneration. RESULTS The primary outcomes were complications and reoperation rate, limb salvage, and primary and secondary patency. Secondary outcome was the incidence of aneurysmatic degeneration of the CHg. Mean diameter of the homografts was 6.3 mm (range, 4-8 mm). In the 30-day postoperative period, 7 PAAs (13%) developed a complication: 3 wound infections, 3 graft thrombosis, and 1 anastomotic bleeding. Six cases needed a reoperation: 2 surgical revascularizations, 2 wound debridement, and 1 anastomotic hemostasis; 1 major amputation was necessary for graft failure after the revascularization. Mean follow-up was 34.8 months (range, 1-96). Five cases (9.3%) developed a graft complication with 4 reoperations necessary (7.4%): 2 grafts required a percutaneous transluminal angioplasty for a perigraft stenosis and 2 underwent a femorodistal bypass in CHg for severe ischemic symptoms after CHg occlusion. Another one CHg occlusion was treated conservatively because it was clinically asymptomatic. Primary patency was 96.3%, 93.9%, and 88.3% at 12, 36, and 60 months, respectively; secondary patency was 98.1% at 12, 36, and 60 months. Freedom from amputation resulted in 98.1%. No aneurysmatic degeneration was observed. Univariate and multivariate analysis showed urgent surgery to be independent risk factors for complications, reoperations, and CHg occlusion (P < 0.05). CONCLUSIONS In this retrospective study, the use of CHg showed to be safe and effective in the surgery of PAAs, either in the short or in the long-term follow-up. Urgent surgery can be considered predictive of graft failure. In our experience, CHg can be considered a good alternative conduit to the autologous saphenous vein.
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Gloviczki P, Huang Y. Commentary: endovascular repair of popliteal artery aneurysm is not yet ready for prime time. J Endovasc Ther 2015; 22:338-40. [PMID: 25904488 DOI: 10.1177/1526602815583489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ying Huang
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Patel SR, Hughes CO, Jones KG, Holt PJE, Thompson MM, Hinchliffe RJ, Karthikesalingam A. A Systematic Review and Meta-analysis of Endovascular Popliteal Aneurysm Repair Using the Hemobahn/Viabahn Stent-Graft. J Endovasc Ther 2015; 22:330-7. [DOI: 10.1177/1526602815579252] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To perform an evidence synthesis study to assess outcomes of endovascular repair of popliteal artery aneurysms (PAAs) using the Hemobahn or Viabahn stent-graft. Methods: A systematic literature review was conducted conforming to established standards to identify articles published between 1996 (the date of introduction of the Hemobahn stent-graft) and 2013 reporting stent-graft repair of PAAs in at least 10 patients. The data were pooled for Kaplan-Meier analysis of primary and secondary patency rates [presented with 95% confidence intervals (CIs)] as the primary outcomes. Random effects meta-analysis was performed for secondary outcomes that included rates of reintervention, endoleak, stent-graft fracture, and limb salvage. Results: Fourteen studies reported outcomes for 514 PAAs. There was considerable heterogeneity in reporting standards among studies. Pooled primary and secondary patency rates were 69.4% (95% CI 63.3% to 76.2%) and 77.4% (95% CI 70.1% to 85.3%), respectively, at 5 years. Five studies (including only one randomized controlled trial) compared surgical to endovascular repair; no difference was found in primary patency on evidence synthesis (hazard ratio 1.30, 95% CI 0.79 to 12.14, p=0.189). Conclusion: Stent-graft repair provides a feasible treatment option for anatomically suitable PAAs. Further studies are required to optimize both patient selection and follow-up protocols.
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Affiliation(s)
- Shaneel R. Patel
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Cían O. Hughes
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Keith G. Jones
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Peter J. E. Holt
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Matt M. Thompson
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
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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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Kumar HR, Rodriguez HE, Eskandari MK. Mid-term outcomes of self-expanding covered stent grafts for repair of popliteal artery aneurysms. Surgery 2015; 157:874-80. [PMID: 25704425 DOI: 10.1016/j.surg.2014.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/14/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Enthusiasm for endovascular therapies has led to the use of stent graft repairs for popliteal artery aneurysms. In this report, we review our experience with this technique. METHODS A retrospective review was performed of all endovascular popliteal artery aneurysm repairs (EVPARs) performed by the vascular surgery group at a tertiary care medical center. Patient demographic data, operative details, and outcomes were examined. RESULTS We performed 33 EVPARs in 28 patients. All patients were male with a mean age of 76 years (range, 60-91). Mean aneurysm diameter was 3.2 cm (range, 1.5-6.3). All repairs were performed using a self-expanding covered stent graft. Among the patients, 18% were symptomatic at the time of repair. The median number of stents used was 2 (range, 1-4). Median duration of stay was 1 day (range, 0-12). The 1-year and 2-year patency were 87% and 81%, respectively, with a mean follow-up of 23 months. Loss of patency was associated with both poor distal runoff (P = .007) and increasing number of stents used (P = .03). Early complications were seen in 4 patients including: stent oversizing leading to in-folding, perforation of a tibial artery, access site hematoma, and access vessel dissection. CONCLUSION As experience with EVPAR continues to grow, caution must be applied in its use. Careful patient selection, proper operative technique, and correct vessel sizing are required for good outcomes. Poor distal runoff and use of numerous stents leads to diminished patency rates.
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Affiliation(s)
- Hari R Kumar
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Wagenhäuser MU, Herma KB, Sagban TA, Dueppers P, Schelzig H, Duran M. Long-term results of open repair of popliteal artery aneurysm. Ann Med Surg (Lond) 2015; 4:58-63. [PMID: 25905015 PMCID: PMC4405004 DOI: 10.1016/j.amsu.2015.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 01/31/2015] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Popliteal artery aneurysms (PAA) are rare. Different surgical techniques for open surgical repair are possible. This study presents a single centre experience using open surgical repair with a medial approach (MA) and outlines differences between symptomatic (SLS) and asymptomatic (ALS) legs. METHODS Data collection was performed retrospectively. The investigation period was from 1 January 1996 to 1 January 2013. Patients presented in the Outpatient Department and received a questionnaire concerning their quality of life. Data are presented as mean ± standard deviation. Mann-Whitney test and Cochran-Armitage test for trend was used for data analysis. Kaplan-Meier method was used to calculate limb salvage rates. p < 0.05 was considered statistically significant. RESULTS We analyzed 16 ALS and 26 SLS with an average age of 63.5 ± 10 years. Preoperative ankle-brachial index (ABI) was 1.0 ± 0.2 for ALS (on control examination: 1.12 ± 0.24) and 0.08 ± 0.18 for SLS (on control examination 0.94 ± 0.14) (p < 0.05). Limb salvage rate was 100% for ALS and 86.7% for SLS (overall 93.3%). Primary patency rate for SLS was 85%, for ALS rate of 100%, respectively (overall 92.5%). ALS reached an average of 13.1 ± 2.7 points (SLS 11.4 ± 2.8) on a numeric point scale. CONCLUSION Open surgery is therapy and prevention of acute ischaemia all in one, especially for asymptomatic patients and delivers good long-term results. Endovascular therapies offer an alternative but long-term results are pending. Open surgery should still be considered as a gold standard therapy.
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Affiliation(s)
- M U Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
| | - K B Herma
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
| | - T A Sagban
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
| | - P Dueppers
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
| | - H Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
| | - M Duran
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany, Moorenstraße. 5, 40225 Düsseldorf, Germany
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Domingues RB, Araújo ACO, van Bellen B. Endovascular treatment of popliteal artery aneurysm. Early and midterm results. Rev Col Bras Cir 2015; 42:37-42. [DOI: 10.1590/0100-69912015001008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/22/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to evaluate the efficacy of endovascular repair of popliteal artery aneurysms on maintaining patency of the stent in the short and medium term. METHODS: this was a retrospective, descriptive and analytical study, conducted at the Integrated Vascular Surgery Service at the Hospital da Beneficência Portuguesa de São Paulo. We followed-up 15 patients with popliteal aneurysm, totaling 18 limbs, treated with stent from May 2008 to December 2012. RESULTS: the mean follow-up was 14.8 months. During this period, 61.1% of the stents were patent. The average aneurysm diameter was 2.5cm, ranging from 1.1 to 4.5cm. The average length was 5cm, ranging from 1.5 to 10 cm. In eight cases (47.1%), the lesion crossed the joint line, and in four of these occlusion of the prosthesis occurred. In 66.7% of cases, treatment was elective and only 33.3% were symptomatic patients treated on an emergency basis. The stents used were Viabahn (Gore) in 12 cases (66.7%), Fluency (Bard) in three cases (16.7%), Multilayer (Cardiatis) in two cases (11.1%) and Hemobahn (Gore) in one case (5.6%). In three cases, there was early occlusion (16.6%). During follow-up, 88.2% of patients maintained antiplatelet therapy. There was no leakage at ultrasound (endoleak). No fracture was observed in the stents. CONCLUSION: the results of this study are similar to other published series. Probably, with the development of new devices that support the mechanical characteristics found on the thighs, there will be improved performance and prognosis of endovascular restoration.
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Dorweiler B, Gemechu A, Doemland M, Neufang A, Espinola-Klein C, Vahl CF. Durability of open popliteal artery aneurysm repair. J Vasc Surg 2014; 60:951-7. [DOI: 10.1016/j.jvs.2014.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/10/2014] [Indexed: 11/26/2022]
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Huang Y, Gloviczki P, Oderich GS, Duncan AA, Kalra M, Fleming MD, Harmsen WS, Bower TC. Outcomes of endovascular and contemporary open surgical repairs of popliteal artery aneurysm. J Vasc Surg 2014; 60:631-8.e2. [DOI: 10.1016/j.jvs.2014.03.257] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
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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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Percutaneous Endovascular Repair of Popliteal Artery Aneurysms. Ann Vasc Surg 2014; 28:1469-72. [DOI: 10.1016/j.avsg.2014.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
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