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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, Overall cumulative survival. Standard error (SE) did not exceed 10% at 60-month follow-up (SE = 8% at 60 months). B, Primary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 12% at 60 months) and C (SE = 13% at 60 months). C, Secondary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 8% at 60 months). SE exceed 10% at 26 months in group A (SE = 12% at 60 months) and at 37 months in group C (SE = 10% at 60 months). D, Freedom from reintervention. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 16% at 60 months) and C (SE = 13% at 60 months).
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Figure 5: A, Overall cumulative survival. Standard error (SE) did not exceed 10% at 60-month follow-up (SE = 8% at 60 months). B, Primary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 12% at 60 months) and C (SE = 13% at 60 months). C, Secondary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 8% at 60 months). SE exceed 10% at 26 months in group A (SE = 12% at 60 months) and at 37 months in group C (SE = 10% at 60 months). D, Freedom from reintervention. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 16% at 60 months) and C (SE = 13% at 60 months).

Mentions: Overall, 5 years estimated survival was 78% (Figure 5A). During follow-up overall graft thrombosis occurred in 14 (21%) patients: 5 (20%) occlusion in group A; 5 (19%) in group B, and 4 (29%) in group C. No significant difference in occlusion incidence between the 3 groups (P = 0.726) was observed during the follow-up. No stent-graft fracture was observed in group A. Mean interval time to thrombosis was 18 (median: 6; r: 0–73; SD: 21) months.


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, Overall cumulative survival. Standard error (SE) did not exceed 10% at 60-month follow-up (SE = 8% at 60 months). B, Primary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 12% at 60 months) and C (SE = 13% at 60 months). C, Secondary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 8% at 60 months). SE exceed 10% at 26 months in group A (SE = 12% at 60 months) and at 37 months in group C (SE = 10% at 60 months). D, Freedom from reintervention. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 16% at 60 months) and C (SE = 13% at 60 months).
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Figure 5: A, Overall cumulative survival. Standard error (SE) did not exceed 10% at 60-month follow-up (SE = 8% at 60 months). B, Primary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 12% at 60 months) and C (SE = 13% at 60 months). C, Secondary patency. SE did not exceed 10% at 60-month follow-up for group B (SE = 8% at 60 months). SE exceed 10% at 26 months in group A (SE = 12% at 60 months) and at 37 months in group C (SE = 10% at 60 months). D, Freedom from reintervention. SE did not exceed 10% at 60-month follow-up for group B (SE = 9% at 60 months). SE exceed 10% at 12 months in group A (SE = 16% at 60 months) and C (SE = 13% at 60 months).
Mentions: Overall, 5 years estimated survival was 78% (Figure 5A). During follow-up overall graft thrombosis occurred in 14 (21%) patients: 5 (20%) occlusion in group A; 5 (19%) in group B, and 4 (29%) in group C. No significant difference in occlusion incidence between the 3 groups (P = 0.726) was observed during the follow-up. No stent-graft fracture was observed in group A. Mean interval time to thrombosis was 18 (median: 6; r: 0–73; SD: 21) months.

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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Related in: MedlinePlus