Natural history, growth rates, and treatment of popliteal artery aneurysms

Jergovic, Iva; Cheesman, Magnus A.; Siika, Antti; Khashram, Manar; Paris, Simon M.; Roy, Joy; Hultgren, Rebecka

doi:10.1016/j.jvs.2021.07.243

Cited by 8 publications

(9 citation statements)

References 44 publications

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“…Interestingly, data on the association between intraluminal thrombus and patent outflow vessels are scarce, despite an obvious connection [28]. Future studies taking into account the aneurysm volume, i.e., thrombus/lumen ratio, could help to broaden the indicatory spectrum in an analogy to AAA, where the aneurysm volume, regardless of ILT, has been suggested to be a more reliable indicator of future repair [9,29].…”

Section: Discussionmentioning

confidence: 99%

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Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

Freytag,

Kapalla,

Berg

et al. 2024

JCM

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Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo–popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3–78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo–popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient’s overall condition should be considered.

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Section: Discussionmentioning

confidence: 99%

“…This approach is currently being investigated to provide better evidence [2,8]. A smaller diameter (<15 mm) upon first diagnosis is associated with more frequent subsequent emergent repairs [8,9]. In general, the annual growth rate varies among individual patients and ranges between 0.7 and 6.5 mm/year, depending on the initial diameter.…”

Section: Introductionmentioning

confidence: 99%

Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

Freytag,

Kapalla,

Berg

et al. 2024

JCM

View full text Add to dashboard Cite

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“…The SVS guidelines focus mainly on quantifying and reporting PAA size [ 7 ]. However, size alone does not singularly dictate the need for operative repair; studies have demonstrated that thrombus burden and the percent of thrombus also portends a high risk of thromboembolic events and amputation [ 4 , 40 , 41 , 42 ]. Manual segmentation of the vessel lumen to identify these high-risk features is difficult given the similar echogenicity of adjacent plaques.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Encord Artificial Intelligence Annotation of Arterial Duplex Ultrasound Images

Bellomo,

Goudot,

Lella

et al. 2023

Diagnostics

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DUS measurements for popliteal artery aneurysms (PAAs) specifically can be time-consuming, error-prone, and operator-dependent. To eliminate this subjectivity and provide efficient segmentation, we applied artificial intelligence (AI) to accurately delineate inner and outer lumen on DUS. DUS images were selected from a cohort of patients with PAAs from a multi-institutional platform. Encord is an easy-to-use, readily available online AI platform that was used to segment both the inner lumen and outer lumen of the PAA on DUS images. A model trained on 20 images and tested on 80 images had a mean Average Precision of 0.85 for the outer polygon and 0.23 for the inner polygon. The outer polygon had a higher recall score than precision score at 0.90 and 0.85, respectively. The inner polygon had a score of 0.25 for both precision and recall. The outer polygon false-negative rate was the lowest in images with the least amount of blur. This study demonstrates the feasibility of using the widely available Encord AI platform to identify standard features of PAAs that are critical for operative decision making.

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“…The latter under the pressure of the cardiac systole can embolize and distally occlude the arteries that originate from the popliteal (tibial vessels) or even, if the thrombus is small, the arterioles of the foot with a phenomenon called ‘microembolization’ [ 68 ]. In these cases, the clinical onset is pain, pallor and hypothermia of the leg or foot because the embolus has produced a reduction in the vascularization of the limb with a consequent picture of ischaemia that will be more or less severe depending on the distal vessels involved [ 69 , 70 ]. The standard treatment for this pathology involves performing a surgical bypass to drain the haematoma and restore the blood supply to the foot.…”

Section: Clinical Applications Of Covered Stentsmentioning

confidence: 99%

Expanded Polytetrafluoroethylene Membranes for Vascular Stent Coating: Manufacturing, Biomedical and Surgical Applications, Innovations and Case Reports

et al. 2023

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Coated stents are defined as innovative stents surrounded by a thin polymer membrane based on polytetrafluoroethylene (PTFE)useful in the treatment of numerous vascular pathologies. Endovascular methodology involves the use of such devices to restore blood flow in small-, medium- and large-calibre arteries, both centrally and peripherally. These membranes cross the stent struts and act as a physical barrier to block the growth of intimal tissue in the lumen, preventing so-called intimal hyperplasia and late stent thrombosis. PTFE for vascular applications is known as expanded polytetrafluoroethylene (e-PTFE) and it can be rolled up to form a thin multilayer membrane expandable by 4 to 5 times its original diameter. This membrane plays an important role in initiating the restenotic process because wrapped graft stent could be used as the treatment option for trauma devices during emergency situations and to treat a number of pathological vascular disease. In this review, we will investigate the multidisciplinary techniques used for the production of e-PTFE membranes, the advantages and disadvantages of their use, the innovations and the results in biomedical and surgery field when used to cover graft stents.

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Natural history, growth rates, and treatment of popliteal artery aneurysms

Cited by 8 publications

References 44 publications

Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

Feasibility of Encord Artificial Intelligence Annotation of Arterial Duplex Ultrasound Images

Expanded Polytetrafluoroethylene Membranes for Vascular Stent Coating: Manufacturing, Biomedical and Surgical Applications, Innovations and Case Reports

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