Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in SwedenCervin, A.; Tjarnstrom, J.; Ravn, H.; Acosta, Stefan; Hultgren, R.; Welander, M.; Bjorck, M. Link to publication Citation for published version (APA): Cervin, A., Tjarnstrom, J., Ravn, H., Acosta, S., Hultgren, R., Welander, M., & Bjorck, M. (2015). Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden. European Journal of Vascular and Endovascular Surgery, 50(3), 342-350. DOI: 10.1016/j.ejvs.2015.03.026 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal WHAT THIS STUDY ADDSPrevious comparisons between open and endovascular repair of popliteal aneurysms have focused on asymptomatic patients, and have short follow up. This study is strengthened by the fact that it is contemporary, population based, without any selection bias, reporting on all kinds of presentations, and has approximately 90% 1 year follow up data. It shows that endovascular repair has significantly inferior results compared with open repair, in particular in the group of patients who present with acute ischaemia. We believe these results will make many vascular surgeons think twice before they treat patients endovascularly in the future. Background: Popliteal aneurysm (PA) is traditionally treated by open repair (OR). Endovascular repair (ER) has become more common. The aim was to describe time trends and compare results (OR/ER).Methods: The Swedish vascular registry, Swedvasc, has a specific PA module. Data were collected (2008e2012) and supplemented with a specific protocol (response rate 99.1%). Data were compared with previously published data (1994e2002) from the same database.Results: The number of operations for PA was 15.7/million person-years (8.3 during 1994e2001). Of 592 interventions for PA (499 patients), 174 (29.4%) were treated for acute ischaemia, 13 (2.2%) for rupture, 105 (17.7%) for other symptoms, and 300 (50.7%) were asymptomatic (31.5% were treated for acute ischaemia, 1994e2002, p ¼ .58). There were no differences in background characteristics between OR and ER in the acute ischaemia group. The symptomatic and asymptomatic groups treated with ER were older (p ¼ .006, p < .001). ER increased 3.6 fold (4.7% 1994e2002, 16.7% 2008e2012, p ¼ .0001 Conclusions: The number of operations for PA doubled while the indications remained similar. ER patency was inferior to OR, especially after treatment for acute...

Objectives This study investigated the relationship between annual hospital volume and the outcomes in carotid endarterectomy and quantified critical volume threshold for this procedure.Data sources PubMed, EMBASE and the Cochrane library were searched for all articles on the volume-outcome relationship in CEA.Review methods Articles were included if they presented data on post-operative mortality and/or stroke rates and annual hospital volume of CEA. The review conformed to the QUOROM statement. The data were meta-analysed and a pooled effect estimate of volume on the stroke and/or mortality rates from CEA quantified, along with the critical volume threshold.Results Twenty-five articles, encompassing 936 436 CEA, were analysed. Significant relationships between mortality rate and stroke rate and annual volume were seen.Overall, the pooled effect estimate was odds ratio 0.78 [95% confidence interval 0.64 -0.92], in favour of surgery at higher volume units, with a critical volume threshold of 79 CEA per annum.Conclusions Significantly lower mortality and stroke rates were achieved at hospitals providing a higher annual hospital volume of CEA. Hospitals wishing to provide CEA should adhere to minimum volume criteria.