Popliteal Artery Aneurysm Repair in the Endovascular Era

Abstract

To compare outcomes of popliteal artery aneurysm (PAA) repair by endovascular treatment, great saphenous vein (GSV) bypass, and prosthetic bypass.Single center retrospective analysis of patients presenting PAA from 2000 to 2013. Patients were divided into endovascular treatment (group A); GSV bypass (group B); and prosthetic graft bypass (group C). Outcomes were technical success, perioperative mortality, and morbidity. Survival, primary and secondary patency, and freedom from reintervention rate were estimated. Differences in ankle-brachial index (ABI), in-hospital length of stay (InH-Los), red blood cell (RBC) transfusion, and limb loss were reported. Mean follow-up was 49 (median: 35; 1–145; SD 42) months.Sixty-seven patients were included; 25 in group A, 28 in group B, and 14 in group C. PAA was symptomatic in 23 (34%) cases. Technical success was 100%. No perioperative death occurred. Three (4.5%) perioperative complications were reported with no significant difference between groups (P = .866). Five-years estimated survival was 78%. Estimated 5-years primary patency for groups A, B, and C was 71%, 81%, and 69%, respectively (P = .19). Estimated 5-years secondary patency for groups A, B, and C was 88%, 85%, and 84% (P = .85). Estimated 5-years freedom from reintervention for groups A, B, and C was 62%, 84%, and 70%, respectively (P = .16). A significant difference between preoperative ABI versus postoperative ABI was observed (P = .001). InH-LoS was significantly shorter in group A (P < .001). RBC transfusions were required significantly less in group A when compared to group C (P = .045). Overall limb salvage was achieved in all but 1 patient.PAA repair has good early and long-term outcomes with different treatment options. Endovascular treatment was not inferior to surgical repair with a reduced InH-LoS and RBC transfusion. It can be successfully employed even in nonelective setting. A randomized controlled trial with long-term follow-up and appropriate patient inclusion criteria is necessary to compare these 3 treatment options.

Tratamento endovascular versus tratamento aberto de aneurisma de artéria poplítea: artigo de revisão

“…The six articles describing retrospective studies were published by Pulli et al, 15 Huang et al, 16 Serrano Hernando et al, 17 Ronchey et al, 18 Cervin et al, 19 and Braga et al, 13 and are summarized in Tables 1 and 2. The metanalyses used were conducted by von Stumm et al, 20 published in 2015 and combining a total of 652 cases, and by Leake et al, 21 published in 2017, covering 14 studies and 4,880 PAA treatments.…”

“…Ronchey et al 18 conducted a retrospective study of 67 PAA patients, dividing them into three groups: A for ET, B for by-pass with the great saphenous vein, and C for prosthetic grafting. Five-year primary patency rates for groups A, B, and C were 71%, 81%, and 69% respectively, with no statistical difference between the three groups.…”

Tratamento de aneurisma de artéria poplítea bilateral

“…13,14 Popliteal aneurysms are often asymptomatic and in general diagnosis is made by physical examination, by palpation of a wide arterial pulse in the popliteal fossa and, incidentally, by imaging exams (ultrasound, angiotomography, and magnetic resonance), which are also used to complement diagnosis and improve surgery planning, primarily when endovascular repair will be attempted. 9 At our service, we normally use ultrasound as the method of choice for anatomic studies of the popliteal artery, because it is a cheaper method that is noninvasive and can be repeated easily, without harm to the patient. 15,16 However, the reliability of ultrasound measurements is examiner dependent.…”

“…7 Treatment is surgical, which can be accomplished using endovascular procedures or open surgery (interposition or bypass with the great saphenous vein reversed or a prosthetic graft), with or without resection of the aneurysm. [8][9][10] This Therapeutic Challenge will discuss these possibilities.…”

Spontaneous giant popliteal artery aneurysm

“…Although endovascular approach is associated with higher reintervention rate, it is preferred to surgery due to short duration of hospital stay, less post-operative pain and need for blood transfusion. The endovascular treatment has anatomic limitations related to popliteal artery and its location but it is not inferior to surgical repair [11,12].…”