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Naazie IN, Willie-Permor D, Haykal T, Harris LM, Hughes K, Malas MB. Association Between Conduit Type and Outcomes After Open Repair of Popliteal Artery Aneurysms. J Surg Res 2023; 291:670-676. [PMID: 37562228 DOI: 10.1016/j.jss.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/20/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Prior studies have demonstrated acceptable midterm outcomes with prosthetic conduits for above-knee bypass for occlusive disease in patients with inadequate segment great saphenous vein (GSV). In this study we aimed to investigate whether this holds true for open repair of popliteal artery aneurysms (PAA). METHODS We queried the Vascular Quality Initiative data for patients who underwent open PAA repair (OPAR). We divided the cohort into three groups based on the conduit used: GSV, other autologous veins, or prosthetic graft. Study outcomes included primary patency, freedom from major amputation, amputation-free survival, and overall survival at 1 y. Kaplan-Meier survival estimates, log-rank tests and multivariable Cox regression were used to compare outcomes between study groups. RESULTS A total of 4016 patients underwent bypass for PAA from January 2010 to October 2021. The three cohorts were significantly different in many demographic and clinical characteristics. The adjusted odds of postoperative amputation among symptomatic patients were 3-fold higher for prosthetic conduits compared to the GSV (odds ratio, 3.20; 95% CI, 1.72-5.92; P < 0.001). For the 1-y outcomes, the adjusted risk of major amputation was almost 3-fold higher for patients with symptomatic disease undergoing bypass with prosthetic conduits (hazard ratio [HR], 2.97; 95% CI, 1.35-6.52; P = 0.007). When compared with GSV, prosthetic conduits were associated with 96% increased risk of death when used for repair in symptomatic patients (adjusted hazard ratio (aHR), 1.96; 95% CI, 1.29-2.97; P = 0.002) but no significant association with mortality in asymptomatic patients (aHR, 0.83; 95% CI, 0.37-1.87; P = 0.652). When compared with GSV, prosthetic conduits were associated with a 2-fold increased risk of 1-y major amputation or death when used for repair in symptomatic patients (aHR, 2.03; 95% CI, 1.40-2.94; P < 0.001) but no significant association with mortality in asymptomatic patients (aHR, 0.91; 95% CI, 0.42-1.98; P = 0.816). Comparing bypass with other veins to the GSV among patients with symptomatic disease, there was no statistically significant difference in major amputation risk (HR; 2.44; 95% CI, 0.55-10.82; P = 0.242) and no difference in the adjusted risk of all-cause mortality (aHR, 0.77; 95% CI, 0.26-2.44; P = 0.653). There were no differences in the adjusted risk of loss of primary patency comparing other veins to GSV (HR, 1.53; 95% CI, 0.85-2.76; P = 0.154) and prosthetic conduits to GSV (HR, 0.85; 95% CI, 0.57-1.26; P = 0.422). CONCLUSIONS This large study shows that among patients undergoing OPAR, 1-y primary patency does not differ between conduit types. However, prosthetic conduits are associated with significantly higher risk of amputation and death compared to GSV among symptomatic patients. Though non-GSV autologous veins are less often used for OPAR, they have comparably acceptable outcomes as GSV.
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Affiliation(s)
- Isaac N Naazie
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California; Division of Vascular and Endovascular Surgery, Department of Surgery, University at Buffalo, Buffalo, New York
| | - Daniel Willie-Permor
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Tony Haykal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Linda M Harris
- Division of Vascular and Endovascular Surgery, Department of Surgery, University at Buffalo, Buffalo, New York
| | - Kakra Hughes
- Division of Cardiothoracic and Vascular Surgery, Howard University Hospital, Washington, District of Columbia
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
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Noory E, Böhme T, Beschorner U, Jacques B, Bürgelin K, Zürn C, Zeller T. Early Results after Exclusion of Popliteal Aneurysms with an Endoprosthesis. CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2022; 6:550-557. [PMID: 36778982 PMCID: PMC9912976 DOI: 10.26502/fccm.92920298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives To evaluate safety and efficacy of endoprosthesis implantation for the exclusion of popliteal artery aneurysm (PAA). Methods Elective asymptomatic patients with aneurysm > 20 mm and symptomatic patients with endovascular therapy of PAA were included. The proportion of patients with critical limb ischemia (presence of rest pain or tissue loss) was high at 32.1%, 21.6% of the patients had acute ischemia with symptoms persisting shorter than 14 days. The primary study endpoint was the target lesion revascularization (TLR) rate at 12 months. Secondary endpoints included technical success, periinterventional adverse events, primary patency at 6, 12 and 24 months, TLR rate at 24 months, predictors on reintervention, change in in clinical symptoms using the Rutherford-Becker classification (RBC), amputation and mortality rate. One hundred thirty-four patients (68.3±10.6 years, 88.8% male) were treated with a Viabahn® endoprosthesis (W.L. Gore & Associates Inc., Flagstaff, AZ, USA). Results The average aneurysm diameter was 2.5±0.87 cm. In 41%, occlusion of the aneurysm was present. TLR rate was 31.3% and 38.8% after 12 and 24 months, respectively. Primary patency rates were 69.1%, 52.3% and 42.6% at 6, 12 and 24 months, respectively. Univariate logistic regression analysis revealed age as a predictor of reintervention and in the multivariable analysis it was treatment with lysis. An improvement in RBC was seen at all-time points. Two major amputations (1.5%) were performed and the mortality rate at 24 months was 5.2%. Conclusion Primary patency rate after endovascular exclusion of PAA is low. However, limb salvage rate is high.
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Affiliation(s)
- Elias Noory
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Tanja Böhme
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ulrich Beschorner
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Börries Jacques
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Karlheinz Bürgelin
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Christina Zürn
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Zeller
- Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Beuschel B, Nayfeh T, Kunbaz A, Haddad A, Alzuabi M, Vindhyal S, Farber A, Murad MH. A systematic review and meta-analysis of treatment and natural history of popliteal artery aneurysms. J Vasc Surg 2021; 75:121S-125S.e14. [PMID: 34058308 DOI: 10.1016/j.jvs.2021.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize the best available evidence comparing open vs endovascular popliteal artery aneurysm (PAA) repair. We also summarized the natural history of PAAs to support of the Society for Vascular Surgery guidelines. METHODS We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate. RESULTS We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at 1 year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30 days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3 years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30 days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18 months and they are frequent. One study showed that at 5 years, approximately one-half of the patients had complications. CONCLUSIONS This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.
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Affiliation(s)
- Brad Beuschel
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Tarek Nayfeh
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Ahmad Kunbaz
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Abdullah Haddad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Muayad Alzuabi
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Shravani Vindhyal
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic Rochester, Rochester, Minn.
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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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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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Elliott JE, Jenkins J. Management of a large ruptured popliteal artery aneurysm involving combined deployment of a covered stent graft and evacuation of popliteal fossa hematoma. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:27-30. [PMID: 32055759 PMCID: PMC7005480 DOI: 10.1016/j.jvscit.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
Popliteal artery aneurysms (PAAs) are the most common of all peripheral aneurysms. However, ruptured PAA is rare, accounting for approximately 2% of PAA presentations. A literature review found only 11 published cases of ruptured PAAs treated with endovascular repair. In this case, a large (6.9 cm in diameter) ruptured PAA was successfully treated with endovascular repair using the GORE VIABAHN (W. L. Gore & Associates, Flagstaff, Ariz) stent graft and had simultaneous evacuation of popliteal fossa hematoma through a medial distal thigh incision. This facilitated more rapid recovery of mobility, reduced pain, and reduced hospital stay and may represent a useful hybrid surgical approach for this rare condition.
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Affiliation(s)
- James Edward Elliott
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jason Jenkins
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Aragão JA, de Miranda FGG, Aragão ICS, Aragão FMS, Reis FP. Treatment of bilateral popliteal artery aneurysms. J Vasc Bras 2019; 19:e20180142. [PMID: 31839798 PMCID: PMC6900880 DOI: 10.1590/1677-5449.180142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities.
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Affiliation(s)
- José Aderval Aragão
- Universidade Federal de Sergipe - UFS, Aracaju, SE, Brasil.,Universidade Tiradentes - UNIT, Aracaju, SE, Brasil
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Ben Hammamia M, Ghedira F, Koubaa MA, Ben Mrad M, Ziadi J, Denguir R. [Short- and long-term outcomes of surgical treatment of popliteal aneurysms]. Ann Cardiol Angeiol (Paris) 2019; 68:215-220. [PMID: 31256902 DOI: 10.1016/j.ancard.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The popliteal artery aneurysm (PAA) is a rare vascular disease, but represents the most common site of peripheral aneurysms. We report in this paper our experience in the surgical management of PAA. OBJECTIVES The aim of this work was to clarify the indications and the results of the surgical management of PAA. METHODS It was a retrospective study, extended over a period of 12years, going from 2007 to 2018, covering 26 patients operated on surgically for popliteal aneurysm. RESULTS We have operated 26 patients for PAA. All patients were male. The average age was 59years [39-80years]. The aneurysm was symptomatic in 22 cases and asymptomatic in 4 cases. The mean aneurysm diameter was 37mm [26-70mm]. Twenty-two patients have received a planned surgery and we did emergency surgery for 4 patients because of a limb ischemia complication. The surgical treatment consisted in a surgical bypass after the aneurysm removing. The restoration of blood continuity was achieved by a vein graft in 23 cases and prosthetic in 3 cases. Three patients needed major amputation within 30days (11.53%) and no mortality was observed during this period. Mean follow-up was 24months [12-96months]. Two-years mortality, complication rate and limb salvage was respectively 7.69%, 15.38% and 84.62%. CONCLUSION The PAA represents a serious disease that can affect the vitality of the lower limb. Surgical treatment is currently the gold standard because of its good results.
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Affiliation(s)
- M Ben Hammamia
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie.
| | - F Ghedira
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie
| | - M A Koubaa
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire La Rabta, Tunis, Tunisie
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Ucci A, Curci R, Azzarone M, Bianchini Massoni C, Bozzani A, Marcato C, Marone EM, Perini P, Tecchio T, Freyrie A, Argenteri A. Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator. Vascular 2018; 26:556-563. [PMID: 29665749 DOI: 10.1177/1708538118771258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.
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Affiliation(s)
- Alessandro Ucci
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Ruggiero Curci
- 2 Unit of Vascular and Endovascular Surgery, ASST Lodi, Maggiore Hospital, Lodi, Italy
| | - Matteo Azzarone
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Claudio Bianchini Massoni
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Bozzani
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Carla Marcato
- 4 Department of Diagnostic and Interventional Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Enrico Maria Marone
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paolo Perini
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Tiziano Tecchio
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Antonio Freyrie
- 1 Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy
| | - Angelo Argenteri
- 3 Unit of Vascular Surgery, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Gonçalves AFF, Pelek CA, Nogueira LS, Carvalho RFD, Stumpf MAM, Gomes RZ, Kluthcovsky ACGC. Comparação entre cirurgia aberta e endovascular no tratamento do aneurisma da artéria poplítea: uma revisão. J Vasc Bras 2018; 17:42-48. [PMID: 29930680 PMCID: PMC5990268 DOI: 10.1590/1677-5449.008817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Os aneurismas de artéria poplítea correspondem a 70% dos aneurismas periféricos e o tratamento é cirúrgico, com controvérsias sobre os resultados da via endovascular. Este estudo objetivou realizar uma revisão da literatura sobre a comparação entre cirurgia aberta e endovascular no tratamento dos aneurismas da artéria poplítea. A pesquisa foi realizada utilizando os termos apropriados nos portais de periódicos LILACS e MEDLINE, com a seleção de 15 artigos. Um total de 5.166 procedimentos cirúrgicos foram comparados, sendo 3.930 cirurgias abertas e 1.236 cirurgias endovasculares. A cirurgia aberta com bypass venoso continua sendo o padrão-ouro. A cirurgia endovascular apresenta menor tempo de internação e é uma opção viável em pacientes eletivos, com baixa expectativa de vida, alto risco cirúrgico, comorbidades e mais idosos, desde que tenham anatomia favorável para o procedimento. Contudo, são necessários estudos de longo prazo para estabelecer os reais benefícios e indicações das duas técnicas, como o ensaio clínico randomizado controlado.
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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: 48] [Impact Index Per Article: 6.9] [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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Zhong S, Zhang X, Chen Z, Dong P, Sun Y, Zhu W, Pan X, Qi D. Endovascular Repair of Blunt Popliteal Arterial Injuries. Korean J Radiol 2016; 17:789-96. [PMID: 27587969 PMCID: PMC5007407 DOI: 10.3348/kjr.2016.17.5.789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/05/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. MATERIALS AND METHODS A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. RESULTS Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18-24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. CONCLUSION Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.
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Affiliation(s)
- Shan Zhong
- Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China
- Department of Medical Imaging, Weifang Medical University, Weifang 261053, P.R.China
| | - Xiquan Zhang
- Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China
| | - Zhong Chen
- Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China
| | - Peng Dong
- Department of Medical Imaging, Weifang Medical University, Weifang 261053, P.R.China
| | - Yequan Sun
- Department of Medical Imaging, Weifang Medical University, Weifang 261053, P.R.China
| | - Wei Zhu
- Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China
| | - Xiaolin Pan
- Department of Interventional Vascular, The 148th Hospital of Chinese People's Liberation Army, Zibo 255300, P.R.China
| | - Deming Qi
- Department of Medical Imaging, Qilu Medical University, Zibo 255200, P.R.China
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