Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: Results of a prospective randomized study

Antonello, Michele; Frigatti, Paolo; Battocchio, Piero; Lepidi, Sandro; Cognolato, Diego; Dall’Antonia, Alberto; Stramanà, Rudi; Deriu, Giovanni P.; Grego, Franco

doi:10.1016/j.jvs.2005.04.049

Cited by 174 publications

(118 citation statements)

References 31 publications

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“…Antonello et al 27 compared, in a randomized study, the results of 15 open repairs with those of 15 endovascular procedures performed in asymptomatic PAAs with good runoff status, and they found no significant differences between the two options at 12-month follow-up, with some advantages for endovascular repair in terms of operative time and hospital stay. The same authors updated their study 23 with the analysis of 21 endovascular procedures compared with 27 open interventions performed in asymptomatic PAAs, and they still found no differences in terms of primary and secondary patency at 72 months, with a 14% rate of late conversion to open surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Pulli¹,

Dorigo²,

Fargion³

et al. 2012

Annals of Vascular Surgery

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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

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Section: Discussionmentioning

confidence: 99%

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

Pulli¹,

Dorigo²,

Fargion³

et al. 2012

Annals of Vascular Surgery

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“…75 Several small trials have been completed that resulted in unexpected Food and Drug Administration approval for the Viabahn endoprosthesis (WL Gore & Associates, Flagstaff, Ariz), with very modest efficacy data to support that decision. 76 In the data submitted for approval, the 1-year SFA patency rate was 62% for the Viabahn device.…”

Section: Covered Stentsmentioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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“…Following PAA repair, patients are invited to attend for duplex ultrasonography (DUS) graft surveillance at 6 weeks, 3,6,9, and 12 months postoperatively and 6 monthly thereafter for the first 5 years. Beyond 5 years, where performed, surveillance is annual.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery for Popliteal Artery Aneurysm

Dattani

Ali

Aber

et al. 2017

Vasc Endovascular Surg

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Objectives:To report outcomes following ligation and bypass (LGB) surgery for popliteal artery aneurysm (PAA) and study factors influencing patient and graft survival. Materials and Methods:A retrospective review of patients undergoing LGB surgery for PAA between September 1999 and August 2012 at a tertiary referral vascular unit was performed. Primary graft patency (PGP), primary-assisted graft patency (PAGP), and secondary graft patency (SGP) rates were calculated using survival analyses. Patient, graft aneurysm-free survival (GAFS), aneurysm reperfusion-free survival (ARFS), and amputation-free survival (AFS) rates were also calculated. Log-rank testing and Cox proportional hazards modeling were used to perform univariate and multivariate analysis of influencing factors, respectively. Results:Eighty-four LGB repairs in 69 patients (mean age 71.3 years, 68 males) were available for study.The 5-year PGP, PAGP, SGP, and patient survival rates were 58.1%, 84.4%, 85.2%, and 81.1%, respectively. On multivariate analysis, the principal determinants of PGP were urgency of operation (P = .009) and smoking status (P = .019). The principal determinants of PAGP were hyperlipidemia status (P = .048) and of SGP were hyperlipidemia (P = .042) and cerebrovascular disease (CVD) status (P = .045). The principal determinants of patient survival were previous myocardial infarction (P = .004) and CVD (P = .001). The 5-year GAFS, ARFS, and AFS rates were 87.9%, 91.6%, and 96.1%, respectively. Conclusion:This study has shown that traditional cardiovascular risk factors, such as a smoking and ischemic heart disease, are the most important predictors of early graft failure and patient death followingLGB surgery for PAA.

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Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: Results of a prospective randomized study

Abstract: We can conclude, with the power limitation of the study, that PAA treatment can be safely performed by using either OR or ET. ET has several advantages, such as quicker recovery and shorter hospital stay.

Cited by 174 publications

References 31 publications

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

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

Endovascular Therapies for Peripheral Arterial Disease

Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery for Popliteal Artery Aneurysm

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