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Popliteal Artery Aneurysm Repair in the Endovascular Era: Fourteen-Years Single Center Experience.

Ronchey S, Pecoraro F, Alberti V, Serrao E, Orrico M, Lachat M, Mangialardi N - Medicine (Baltimore) (2015)

Bottom Line: RBC transfusions were required significantly less in group A when compared to group C (P = 0.045).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.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Vascular Surgery, San Filippo Neri Hospital, Rome (SR, VA, ES, MO, NM); Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Palermo, Italy (FP); and Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland (ML).

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 = 0.866). Five-years estimated survival was 78%. Estimated 5-years primary patency for groups A, B, and C was 71%, 81%, and 69%, respectively (P = 0.19). Estimated 5-years secondary patency for groups A, B, and C was 88%, 85%, and 84% (P = 0.85). Estimated 5-years freedom from reintervention for groups A, B, and C was 62%, 84%, and 70%, respectively (P = 0.16). A significant difference between preoperative ABI versus postoperative ABI was observed (P = 0.001). InH-LoS was significantly shorter in group A (P < 0.001). RBC transfusions were required significantly less in group A when compared to group C (P = 0.045). 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.

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A, Intraoperative frontal view arteriogram. Popliteal artery aneurysm. B, Intraoperative frontal view arteriogram. Popliteal artery aneurysm exclusion after stent-graft deployment.
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Figure 2: A, Intraoperative frontal view arteriogram. Popliteal artery aneurysm. B, Intraoperative frontal view arteriogram. Popliteal artery aneurysm exclusion after stent-graft deployment.

Mentions: All endovascular procedures were performed in an operating room equipped with digital fluoroscopic C-arm (Euroampli ALIEN, Eurocolumbus, Italy) to allow a prompt conversion to open surgery if necessary. A vascular surgeon performed all procedures under general (5) or local anesthesia (20). In 17 cases access to PAA was omolater through a femoral cut-down; in the remaining 8 cases PAA was accessed percutaneously though the contralateral femoral artery. A weight-adjusted bolus of heparin was administrated intravenously and an intraoperative angiogram was performed to confirm the PAA location. In all cases the Viabahn Endoprosthesis (Gore, Flagstaff, Arizona) was employed to exclude the PAA. Stent-grafts were deployed with a minimum of 1.5 cm of proximal and distal landing zone (Figure 2). Stent-grafts size was chosen with 1 mm oversizing. A mean of 1.44 (r: 1–3; SD: 0.7) stent-grafts per patient was employed. A preoperative fibrinolysis was employed in 4 (16%) patients due to acute PAA thrombosis. A completion arteriography with knee in flection (>90°) was performed to assess the stent-graft flexibility (Figure 3). All patients underwent to dual antiplatelet regimen for at least 1 month.


Popliteal Artery Aneurysm Repair in the Endovascular Era: Fourteen-Years Single Center Experience.

Ronchey S, Pecoraro F, Alberti V, Serrao E, Orrico M, Lachat M, Mangialardi N - Medicine (Baltimore) (2015)

A, Intraoperative frontal view arteriogram. Popliteal artery aneurysm. B, Intraoperative frontal view arteriogram. Popliteal artery aneurysm exclusion after stent-graft deployment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554107&req=5

Figure 2: A, Intraoperative frontal view arteriogram. Popliteal artery aneurysm. B, Intraoperative frontal view arteriogram. Popliteal artery aneurysm exclusion after stent-graft deployment.
Mentions: All endovascular procedures were performed in an operating room equipped with digital fluoroscopic C-arm (Euroampli ALIEN, Eurocolumbus, Italy) to allow a prompt conversion to open surgery if necessary. A vascular surgeon performed all procedures under general (5) or local anesthesia (20). In 17 cases access to PAA was omolater through a femoral cut-down; in the remaining 8 cases PAA was accessed percutaneously though the contralateral femoral artery. A weight-adjusted bolus of heparin was administrated intravenously and an intraoperative angiogram was performed to confirm the PAA location. In all cases the Viabahn Endoprosthesis (Gore, Flagstaff, Arizona) was employed to exclude the PAA. Stent-grafts were deployed with a minimum of 1.5 cm of proximal and distal landing zone (Figure 2). Stent-grafts size was chosen with 1 mm oversizing. A mean of 1.44 (r: 1–3; SD: 0.7) stent-grafts per patient was employed. A preoperative fibrinolysis was employed in 4 (16%) patients due to acute PAA thrombosis. A completion arteriography with knee in flection (>90°) was performed to assess the stent-graft flexibility (Figure 3). All patients underwent to dual antiplatelet regimen for at least 1 month.

Bottom Line: RBC transfusions were required significantly less in group A when compared to group C (P = 0.045).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.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Vascular Surgery, San Filippo Neri Hospital, Rome (SR, VA, ES, MO, NM); Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Palermo, Italy (FP); and Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland (ML).

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 = 0.866). Five-years estimated survival was 78%. Estimated 5-years primary patency for groups A, B, and C was 71%, 81%, and 69%, respectively (P = 0.19). Estimated 5-years secondary patency for groups A, B, and C was 88%, 85%, and 84% (P = 0.85). Estimated 5-years freedom from reintervention for groups A, B, and C was 62%, 84%, and 70%, respectively (P = 0.16). A significant difference between preoperative ABI versus postoperative ABI was observed (P = 0.001). InH-LoS was significantly shorter in group A (P < 0.001). RBC transfusions were required significantly less in group A when compared to group C (P = 0.045). 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.

Show MeSH
Related in: MedlinePlus