Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report

Grip, Olivia; Mani, Kevin; Altreuther, Martin; Gonçalves, Frederico Bastos; Beiles, Barry; Cassar, Kevin; Davidović, Lazar; Eldrup, Nikolaj; Lattmann, Thomas; Laxdal, E.; Menyhei, Gábor; Setacci, Carlo; Settembre, Nicla; Thomson, Ian; Venermo, Maarit; Björck, Martin

doi:10.1016/j.ejvs.2020.07.005

Cited by 28 publications

(24 citation statements)

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“…26 In a recent large international study of 10 764 PA repairs, early amputation and death were higher after acute than elective surgery A B C (5.0% vs. 0.7%; 1.9% vs. 0.5%) with a similar difference after one year, highlighting the importance of matching for indication when comparing the techniques. 4 In this population based study, both primary and secondary patency strongly favoured OSR. Secondary patency was lower than in most previously published cohorts of ER, 10,24,27,28 only 69% at one year, probably a result of the high proportion of patients treated for acute ischaemia, at 32%.…”

Section: Discussionmentioning

confidence: 64%

“…The indications, treatments, and outcomes of the original cohort of 592 legs, were compared with Swedvasc data 2014 e 2018. 4 Indications for treatment and choice of technique were similar (Table 4). Patients were older during the later time period (69 vs. 72 years, p < .001).…”

Section: Ad Hoc Analysismentioning

confidence: 99%

“…An ad hoc analysis was performed comparing PA treatment from the time period 2008 e 2012 with a more recent time period, based on Swedvasc data. 4 During the years 2014 to 2018, 899 legs were compared with the original, cross checked cohort of 592 legs from May 2008 to May 2012. There were differences in registrations in the two time periods.…”

Section: A B Cmentioning

confidence: 99%

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Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

Cervin

Acosta

Hultgren

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Previous comparisons between open surgical (OSR) and endovascular (ER) repair for popliteal aneurysms (PA) were hampered by differing subgroups of patients being selected for the different treatments. ER was often chosen for asymptomatic patients with good outflow, but also for elderly and frail patients, and when no suitable vein was available for bypass. A small, randomised trial was published, but it included only asymptomatic patients. This investigation is the first attempt to identify risk factors for occlusion in a large, population based, cohort with comparable groups, including anatomical data by examining all imaging in a core lab. Objective: To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. Methods: A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 e 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 e 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion.Results: Patients in the ER group were older (73 vs. 68 years, p ¼ .001), had more lung disease (p ¼ .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 e 4.55, p < .001) for ER, but 3.03 (1.26 e 7.27, p ¼ .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 e 4.50, p ¼ .003), but 4.68 (1.89 e 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 e 5.97], p ¼ .003; and poor outflow HR 14.39 [3.46 e 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 e 0.93], p ¼ .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 e 1.033], p ¼ .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 e 2012 and 2014 e 2018). Conclusion:In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.

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Section: Discussionmentioning

confidence: 64%

Section: Ad Hoc Analysismentioning

confidence: 99%

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Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

Cervin

Acosta

Hultgren

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…Open repair via a medial or posterior approach represents the standard treatment for large or symptomatic popliteal artery aneurysms and consist in aneurysm exclusion with autologous or prosthetic bypass grafting. Recently, percutaneous implantation of the PTFE-covered stents is considered an alternative approach associated with low perioperative morbidity and mortality [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Off-Label Use of a Double-Layer Micromesh Carotid Stent for Hybrid Treatment of Popliteal Artery Aneurism Complicated by Chronic Distal Embolization

Barat

Casian

2021

Case Reports in Vascular Medicine

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We report our initial experience in off-label use of the double-layer micromesh (DLM) Roadsaver® stent for the hybrid treatment of a fusiform popliteal artery aneurism complicated by distal embolization and chronic limb threatening ischemia in a COVID-19-positive young male. A 36-year-old male patient was admitted with chronic limb threatening ischemia of the left lower limb. The duplex ultrasound and computer tomography angiography (CTA) demonstrated a fusiform popliteal artery aneurism with a maximal diameter of 14 mm and distal occlusion of peroneal and both tibial arteries. Urgent hybrid intervention was performed, starting with an open thrombectomy from the distal posterior tibial artery via a retromalleolar access followed by percutaneous deployment of the DLM Roadsaver® stent (Terumo, Tokyo, Japan) for the exclusion of the popliteal artery aneurism. The flow diverting effect was observed immediately with contrast stagnation in the asymmetrical part of the aneurism sac (grade C2 of the O’Kelly-Marotta flow diversion scale). The procedure was uneventful, with the regaining of an adequate foot perfusion and palpable pulse at the posterior tibial artery. On the 2nd postoperative day, the patient was diagnosed with a symptomatic form of COVID-19 infection and transferred to a dedicated facility. At a one-month follow-up, the patient had no symptoms of limb ischemia and CTA showed complete thrombosis of the aneurism sac, absence of endoleaks, and patency of the treated arterial segment. This case demonstrates the possibility of off-label use of the DLM Roadsaver® stent for hybrid treatment of popliteal artery aneurism complicated by distal embolization and critical limb ischemia.

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“…A nyitott és az endovascularis érsebészeti beavatkozásokról gyűjtött adatok felhasználása kettős célú volt az elmúlt két évtizedben. Egyrészt hazánk, csatlakozva a VASCUNET-hez, számos nemzetközi tanulmányban vett részt [4][5][6][7][8], másrészt a hazai publikációk hozzájárultak a magyarországi érsebészet korszerűsítésének megkezdéséhez, megvalósítva ezzel a regiszter számára kitűzött egyik fő célt [9,10].…”

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Infrarenalis aortaaneurysma-műtétek országos eredményeinek elemzése a Nemzeti Érsebészeti Regiszter alapján (2010–2019)

Hidi

Pál

Boros

et al. 2021

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Összefoglaló. Bevezetés: Az elmúlt évtizedekben számos országban jelentős mértékben változott a hasi aortaaneurysmák sebészi kezelése az eredményesebb ellátás céljából: endovascularis beavatkozások terjedése, nagy betegforgalmú aortacentrumok kialakítása. Célkitűzés: A Magyarországon, infrarenalis aortaaneurysmák miatt végzett beavatkozások rövid távú eredményeinek elemzése elsősorban műtéti technika (endovascularis vs. nyitott aortareconstructio), intézeti betegforgalom (kis vs. nagy betegforgalmú intézet) és időszak (2010–2014 vs. 2015–2019) alapján. Módszer: A Nemzeti Érsebészeti Regiszterben 2010. 01. 01. és 2019. 12. 31. között prospektíven rögzített multicentrikus adatok retrospektív feldolgozása. Eredmények: A regiszterben 3206 infrarenalis aortaaneurysma-műtétet rögzítettek. A második öt évben jelentősen nőtt az endovascularis aortareconstructio aránya a nyitotthoz képest (p<0,0001), illetve a nagy betegforgalmú intézetek szignifikánsan több rupturált aortaaneurysmát láttak el, mint a kis betegforgalmú intézetek (p<0,0001) az első öt évhez viszonyítva. A perioperatív mortalitás rupturált aortaaneurysma miatt a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekkel szemben az első öt évben (p = 0,0011), illetve a nagy betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a nyitottal szemben a második öt évben (p = 0,029). A nem rupturált aortaaneurysma-műtétek perioperatív mortalitása a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekhez képest az első és a második öt évben is (p = 0,0007; p = 0,004). Mind a nagy, mind a kis betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a perioperatív mortalitás a második öt évben (p<0,0001; p<0,0001). A rupturált és a nem rupturált aortaaneurysmák perioperatív mortalitásának független rizikófaktora az intézetek betegforgalma (p = 0,006; p = 0,004), a betegek életkora (p<0,0001; p = 0,001), a preoperatív renalis megbetegedés (p = 0,007; p = 0,007), a transzfúzióigény (p<0,0001; p<0,0001), illetve nem rupturált aortaaneurysmák esetében a műtéti technika (p<0,0001) is. Következtetés: Endovascularis aortareconstructio és nagy betegforgalmú intézetek esetében szignifikánsan alacsonyabb perioperatív mortalitás érhető el. Orv Hetil. 2021; 162(31): 1233–1243. Summary. Introduction: The organisation of aortic disease care has changed significantly in many countries over the last decade: centralized, high-volume centers were established. Objective: To analyse the perioperative mortality and the number of the infrarenal aortic aneurysm repairs according to the type of procedure (endovascular vs. open), patient volume (low vs. high) and time period (2010–2014 vs. 2015–2019). Methods: The multicentric data registered prospectively in the Hungarian National Vascular Registry between 01. 01. 2010 and 31. 12. 2019 were analysed retrospectively. Results: 3206 infrarenal aortic aneurysms were recorded. The endovascular-open repair rate was significantly higher (p<0.0001) and the high-volume institutes managed significantly more ruptured aneurysms (p<0.0001) in the second period. The perioperative mortality of the open repair of ruptured aneurysms was significantly lower in the high-volume institutes than in the low-volume ones in the first period (p = 0.0011), and the mortality of endovascular repair was significantly lower compared with open repair in the high-volume institutes in the second period (p = 0.029). The perioperative mortality of the open repair of non-ruptured aneurysm was significantly lower in the high-volume institutes in both periods (p = 0.0007; p = 0.004). Furthermore, the mortality of endovascular repair was significantly lower compared with open repair both in the high- and the low-volume institutes in the second period (p<0.0001; p<0.0001). Patient volume (p = 0.006; p = 0.004), age (p<0.0001; p = 0.001), preoperative renal insufficiency (p = 0.007; p = 0.007) and the need of blood transfusion (p<0.0001; p<0.0001) were independent risk factors of the perioperative mortality of ruptured and non-ruptured aneurysms. Type of the procedure was also an independent risk factor in the case of non-ruptured aneurysms (p<0.0001). Conclusion: Endovascular repair and aortic surgery in the high-volume institutes result in significantly lower perioperative mortality. Orv Hetil. 2021; 162(31): 1233–1243.

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Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report

Cited by 28 publications

References 45 publications

Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

Off-Label Use of a Double-Layer Micromesh Carotid Stent for Hybrid Treatment of Popliteal Artery Aneurism Complicated by Chronic Distal Embolization

Infrarenalis aortaaneurysma-műtétek országos eredményeinek elemzése a Nemzeti Érsebészeti Regiszter alapján (2010–2019)

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