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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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Intraoperative view of a short great saphenous vein bypass with posterior approach.
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Figure 4: Intraoperative view of a short great saphenous vein bypass with posterior approach.

Mentions: All procedures were performed under general anesthesia. A medial approach was chosen in 12 cases: these bypasses were performed according to the standard technique with surgical exposure of femoral bifurcation or proximal superficial femoral artery as inflow source. The distal popliteal artery was chosen as distal outflow point when possible; if not available the tibio-pernoeal trunk was the second option. For the medial approach, the bypass conduit was an autologous GSV in 10 cases and a prosthetic PTFE graft in 2 cases. The posterior approach was used in 30 cases and performed with patients in prone position using an S-shaped incision in correspondence of the popliteal fossa. The conduit for this approach was an autologous GSV in 18 cases and a prosthetic PTFE graft in 12 (Figure 4). The PTFE synthetic grafts employed were gelatin-coated PTFE (Vascutek Ltd, Renfrewshire, UK) grafts in 13 cases and heparin-bonded ePTFE (Propaten Gore-Tex; WL Gore & Associates Inc, Flagstaff, Ariz) graft in the remaining case.


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)

Intraoperative view of a short great saphenous vein bypass with posterior approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Intraoperative view of a short great saphenous vein bypass with posterior approach.
Mentions: All procedures were performed under general anesthesia. A medial approach was chosen in 12 cases: these bypasses were performed according to the standard technique with surgical exposure of femoral bifurcation or proximal superficial femoral artery as inflow source. The distal popliteal artery was chosen as distal outflow point when possible; if not available the tibio-pernoeal trunk was the second option. For the medial approach, the bypass conduit was an autologous GSV in 10 cases and a prosthetic PTFE graft in 2 cases. The posterior approach was used in 30 cases and performed with patients in prone position using an S-shaped incision in correspondence of the popliteal fossa. The conduit for this approach was an autologous GSV in 18 cases and a prosthetic PTFE graft in 12 (Figure 4). The PTFE synthetic grafts employed were gelatin-coated PTFE (Vascutek Ltd, Renfrewshire, UK) grafts in 13 cases and heparin-bonded ePTFE (Propaten Gore-Tex; WL Gore & Associates Inc, Flagstaff, Ariz) graft in the remaining case.

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