Comparison of Early and Midterm Results of Open and Endovascular Treatment of Popliteal Artery Aneurysms

Abstract

Background: Aim of this study was to retrospectively compare perioperative (<30 days) and 2-year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience. Methods: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by c 2 text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by KaplaneMeier curves, and differences in the two groups were assessed by log-rank test. Results: There were no differences between the two groups in terms of sex, age, risk factors for atherosclerosis, and comorbidities; PAAs were symptomatic in 48% of cases in group 1 and in 29% in group 2 (P ¼ 0.1). Fifteen patients with mild-to-moderate acute ischemia due to PAA thrombosis underwent preoperative intra-arterial thrombolysis, 13 in group 1 and 2 in group 2. In open surgery group, nine cases were treated with aneurysmectomy and prosthetic graft interposition, and in seven cases, the aneurysm was opened and a prosthetic graft was placed inside the aneurysm. In 27 cases, ligation of the aneurysm with bypass grafting (21 prosthetic grafts and 6 autologous veins) was carried out. In group 2, 20 patients had endoprosthesis placement, whereas in the remaining patient, a multilayer nitinol stent was used. There was one perioperative death in a patient of group 2 who underwent concomitant endovascular aneurysm repair and PAA endografting. Cumulative 30-day death and amputation rate was 4.5% in group 1 and 4.7% in group 2 (P ¼ 0.9). Follow-up was available in 61 interventions (96%) with a mean follow-up period of 22.5 months (range: 1e60). Estimated primary patency rates at 24 months were 78.1% in group 1 and 59.4% in group 2 (P ¼ 0.1). Freedom from reintervention rates at 24 months were 79% in group 1 and 61.5% in group 2 (P ¼ 0.2); estimated 24-month secondary patency rates were 81.6% in group 1 and 78.4% in group 2 (P ¼ 0.9), and freedom from amputation rates were 92.7% and 95%, respectively (P ¼ 0.7). Conclusions: Endovascular treatment of PAAs provided, in our initial experience, satisfactory perioperative and 1-year results, not significantly different from those obtained with prosthetic

Flow-diverting stents for the treatment of arterial aneurysms

“…[6][7][8][9] Two were included in the analysis. 7,9 Of 14 articles that we considered, 12 reported the use of FDSs in arterial aneurysms (Table I), 1,7,[9][10][11][12][13][14][15][16][17][18] one in thoracoabdominal dissection, 19 and one in carotid blowout syndrome. 20 The full texts of these articles were retrieved and reviewed.…”

Two Decades of Endovascular Repair of Popliteal Artery Aneurysm—A Meta-analysis

“…23 Similarly, in 2012, Pulli et al published a study of EVR and OSR of PAAs, which contained data from 2005 to 2010. 24 One year later, in 2013, they released a new study with patient data from 2000 to 2011. 25 Stone et al also published two studies, one in 2005 and one in 2013.…”

“…26,27 The first dealt with patient records from 1995 to 2004, 26 and the second with data from 2001 to 2011. 27 The first series of studies was excluded 22,24,26 ; only the most recent studies with the lengthiest follow up data were selected for this analysis.…”

Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair

“…For example, most single or even multicenter trials include symptomatic and asymptomatic patients in their analyses. [7][8][9][10][11][12] The inclusion of symptomatic patients with varying degrees of outflow abnormalities introduces a certain degree of bias that renders the interpretation of results difficult.…”

“…5 Published comparative studies of current PAA management are somewhat conflicting: some authors suggest equipoise of the two treatment options, 6,7 whereas others advocate advantages of open repair over endovascular repair. 8 Few studies have used different analytic methodologies to directly compare outcomes after OPAR with those after EPAR, [6][7][8][9][10][11][12] and the only published prospective, randomized trial that evaluated outcomes after OPAR and EPAR included just 30 patients. 6 The decision to undertake OPAR or EPAR varies widely among practitioners and is based on a range of factors, including disease pattern, availability of autogenous conduit, surgical and endovascular skill sets, access to an appropriate procedural environment, and practitioner bias.…”