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Freytag H, Kapalla M, Berg F, Stroth HCA, Reisenauer T, Stoklasa K, Zimmermann A, Reeps C, Knappich C, Wolk S, Busch A. Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures. J Clin Med 2024; 13:2817. [PMID: 38792357 PMCID: PMC11122537 DOI: 10.3390/jcm13102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo-popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3-78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo-popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient's overall condition should be considered.
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Affiliation(s)
- Hannah Freytag
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Floris Berg
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hans-Christian Arne Stroth
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Tessa Reisenauer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Kerstin Stoklasa
- Department of Vascular Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
| | - Steffen Wolk
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
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Jung G, Leinweber ME, Karl T, Geisbüsch P, Balzer K, Schmandra T, Dietrich T, Derwich W, Gray D, Schmitz-Rixen T. Real-world data of popliteal artery aneurysm treatment. Analysis of the POPART registry. J Vasc Surg 2022; 75:1707-1717.e2. [PMID: 35066058 DOI: 10.1016/j.jvs.2021.12.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Popliteal artery aneurysm (PAA) is a rare disease with a prevalence of 0.1-1%. Within the last years, endovascular repair of PAA (ER) has been performed more frequently despite the lack of high-level evidence compared to open surgery (OR). In 2014, the POPART registry was initiated to validate current treatment options in PAA repair.
METHOD: POPART is a multinational multicenter registry for peri- and postoperative outcome of endovascular and open PAA repair. Data sets are recorded by the online survey tool "SurveyMonkey®". Regular monitoring and plausibility checks of the data sets are performed to ensure reliability. The aim of this study is to present results of the POPART registry, with data of 41 centers.
RESULTS: From June 2014 to August 2019, a total of 794 cases were recorded in the PAA registry. OR was performed in 662 patients and ER in 106 patients; 23 Patients were treated conservatively. Four of the 106 patients with primary ER underwent conversion to OR. ER patients were significantly older (ER x˜= 71 vs. OR x˜= 67 (p<0.05). There were no other significant differences in demographics or comorbidities and aneurysm morphology between the two groups. 50.3% patients in the OR group were symptomatic; in the ER group 29.2% (p<0.05). Emergency treatment for acute ischemia, critical ischemia or rupture was necessary in 149 patients (22.5%) in the OR group vs. 11 patients (10.3%) in the ER group.
Most frequent complications after surgery were impaired wound healing (OR n=47, 7.1%; ER n=3, 2.8%, p>0.05) and major bleeding (OR n=26, 3.9%; ER n=3, 2.8%, p>0.05). In-hospital length of stay (= 10d [3-65] OR vs. x˜=7d [1-73] ER) was significantly higher in the OR group. Overall patency was 83.2% vs. 44.7% (OR/ER, p<0.005) after 12 months and 74.2% vs. 29.1% (OR/ER, p<0.005) after 24 months. There was a significantly poorer outcome for prosthetic graft compared to autologous vein in the OR group (71.4% vs. 88.1% 12-month primary patency).
CONCLUSION:
In order to evaluate new treatment techniques such as endovascular repair (ER) for PAA, real world data is of essential importance. This analysis of the first results for the POPART registry shows good perioperative results for endovascular treatment of PAA in asymptomatic patients with good outflow vessels. The perioperative complication rate is low and the postoperative hospital stay is shorter than after OR. However, the patency rates after 12 and 24 months are low in the ER group compared to patients treated with open repair. More follow-up data is required for further interpretation; the completion of the data sets in the registry is ongoing.
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Affiliation(s)
- Georg Jung
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany.
| | - Maria-Elisabeth Leinweber
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Philipp Geisbüsch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart- Katharinenhospital, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St.-Marien-Hospital, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular and Endovascular Surgery, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
| | - Tanja Dietrich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Daphne Gray
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt am Main, Germany; German Institute of Vascular Public Health Research, Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG), Berlin, Germany
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3
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Pantoja JL, Rigberg DA, Gelabert HA. The evolving role of endovascular therapy in the management of arterial thoracic outlet syndrome. J Vasc Surg 2021; 75:968-975.e1. [PMID: 34695555 DOI: 10.1016/j.jvs.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Over the past two decades, vascular surgeons have successfully incorporated endovascular techniques to the routine care of patients with arterial thoracic outlet syndrome (ATOS). However, no reports have documented the impact of endovascular therapy. This study describes the trends in management of ATOS by vascular surgeons and outcomes after both endovascular and open repair of the subclavian artery. METHODS We queried a single-institution, prospectively maintained thoracic outlet syndrome database for ATOS cases managed by vascular surgeons. For comparison, cases were divided into two equal time periods, January 1986 to August 2003 (P-1) vs September 2003 to March 2021 (P-2), and by treatment modality, open vs endovascular. Clinical presentation, outcomes, and the involvement of vascular surgeons in endovascular therapy were compared between groups. RESULTS Of 2200 thoracic outlet syndrome cases, 51 were ATOS (27 P-1, 24 P-2) and underwent 50 transaxillary decompressive operations. Forty-eight cases (92%) presented with ischemic symptoms. Thrombolysis was done in 15 (29%). During P-1, vascular surgeons performed none of the catheter-based interventions. During P-2, vascular surgeons performed 60% of the angiograms, 50% of thrombolysis, and 100% of stent grafting. Subclavian artery pathology included 16 aneurysms (31%), 15 stenoses (29%), and 19 occlusions (37%). Compared with open aneurysmal repair, endovascular stent graft repairs took less time (241 vs 330 minutes; P = .09), incurred lower estimated blood loss (103 vs 150 mL; P = .36), and had a shorter length of stay (2.4 vs 5.0 days; P = .10). Yet the endovascular group had decreased primary (63% vs 77%; P = .481), primary assisted (75% vs 85%; P = .590), and secondary patency rates (88% vs 92%; P = .719), at a mean follow-up time of 3.0 years for the endovascular group and 6.9 years for the open group (P = .324). These differences did not achieve statistical significance. Functionally, 84% of patients were able to resume work or school. A majority of patients (88%) had a good to excellent functional outcome based on their Derkash score. Somatic pain scores and QuickDASH (disabilities of the arm, shoulder, and hand) scores decreased postoperatively, 2.9 vs 0.8 (P = .015) and 42.6 vs 12.6 (P = .004), respectively. CONCLUSIONS This study describes the evolving role of endovascular management of ATOS over the past two decades and documents the expanded role of vascular surgeons in the endovascular management of ATOS at a single institution. Compared with open repair, stent graft repair of the subclavian artery may be associated with shorter operative times, less blood loss, but decreased patency, without changes in long-term functional outcomes.
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Affiliation(s)
- Joe Luis Pantoja
- Division of Vascular Surgery, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, Calif.
| | - David A Rigberg
- Division of Vascular Surgery, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, Calif
| | - Hugh A Gelabert
- Division of Vascular Surgery, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, Calif
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Nakashima M, Kobayashi M. Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms. Vasc Specialist Int 2021; 37:37-40. [PMID: 33795552 PMCID: PMC8021490 DOI: 10.5758/vsi.200077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. We have presented a case of PAA in an 81-year-old woman complaining of tingling sensations in her leg. Computed tomography revealed a large 10-cm sized PAA. Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein.
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Affiliation(s)
- Masaya Nakashima
- Department of Vascular Surgery, Tokoname Municipal Hospital, Tokoname, Japan
| | - Masayoshi Kobayashi
- Department of Cardiovascular surgery, Fujita Health University Graduate School of Medicine, Toyoake, Japan
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5
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Conti M, Ferrarini A, Finotello A, Salsano G, Auricchio F, Palombo D, Spinella G, Pane B. Patient-specific computational fluid dynamics of femoro-popliteal stent-graft thrombosis. Med Eng Phys 2020; 86:57-64. [PMID: 33261734 DOI: 10.1016/j.medengphy.2020.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023]
Abstract
Intra-stent thrombosis is one of the major failure modes of popliteal aneurysm endovascular repair, especially when the diseased arterial segment is long and requires overlapping stent-grafts having different nominal diameters in order to accommodate the native arterial tapering. However, the interplay between stent sizing, post-operative arterial tortuosity, luminal diameter, local hemodynamics, and thrombosis onset is not elucidated, yet. In the present study, a popliteal aneurysm was treated with endovascular deployment of two overlapped stent-grafts, showing intra-stent thrombosis at one-year follow-up examination. Patient-specific computational fluid-dynamics analyses including straight- and bent-leg position were performed. The computational fluid-dynamics analysis showed that the overlapping of the stent-grafts induces a severe discontinuity of lumen, dividing the stented artery in two regions: the proximal part, affected by thrombosis, is characterized by larger diameter, low tortuosity, low flow velocity, low helicity, and low wall shear stress; the distal part presents higher tortuosity and smaller lumen diameter promoting higher flow velocity, higher helicity, and higher wall shear stress. Moreover, leg bending induces an overall increase of arterial tortuosity and reduces flow velocity promoting furtherly the luminal area exposed to low wall shear stress.
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Affiliation(s)
- Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy.
| | - Anna Ferrarini
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Alice Finotello
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Italy
| | - Giancarlo Salsano
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Wrede A, Acosta S. Outcome of Open and Endovascular Repair in Patients with Acute Limb Ischemia Due to Popliteal Artery Aneurysm. Ann Vasc Surg 2020; 67:376-387. [DOI: 10.1016/j.avsg.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 11/26/2022]
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7
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Seiler R, Turkalj I, Gähwiler R, Isaak A, Thalhammer C, Rastan A. Symptomatic type I endoleak following popliteal artery aneurysm repair. VASA 2020; 49:514-517. [PMID: 32697149 DOI: 10.1024/0301-1526/a000899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of a symptomatic type Ib endoleak following popliteal artery aneurysm repair with successful interventional therapy introduces a short review of the limited literature to this relevant potential complication. Illustration of important factors supporting endoleak formation after endovascular popliteal artery repair and recommendation of a consequent surveillance are discussed.
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Affiliation(s)
- Rebekka Seiler
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
| | - Igor Turkalj
- Health Centre Fricktal, Internal Medicine, Laufenburg, Switzerland
| | - Roman Gähwiler
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
| | - Andrej Isaak
- Vascular Surgery, University Centre Aarau-Basel, Aarau, Switzerland
| | | | - Aljoscha Rastan
- Angiology, University Hospital, Cantonal Hospital, Aarau, Switzerland
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Joshi D, Gupta Y, Ganai B, Mortensen C. Endovascular versus open repair of asymptomatic popliteal artery aneurysm. Cochrane Database Syst Rev 2019; 12:CD010149. [PMID: 31868929 PMCID: PMC6927522 DOI: 10.1002/14651858.cd010149.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Popliteal artery aneurysm (PAA) is a focal dilatation and weakening of the popliteal artery. If left untreated, the aneurysm may thrombose, rupture or the clot within the aneurysm may embolise causing severe morbidity. PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. The success of the procedure is gauged by the ability of the graft to stay patent over an extended duration. While surgical treatment is usually preferred in an emergency, the evidence on first line treatment in a non-emergency setting is unclear. This is an update of a review first published in 2014. OBJECTIVES To assess the effectiveness of an endovascular stent graft versus conventional open surgery for the treatment of asymptomatic popliteal artery aneurysms (PAA) on primary and assisted patency rates, hospital stay, length of the procedure and local complications. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 29 January 2019. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing endovascular stent grafting versus conventional open surgical repair in patients undergoing unilateral or bilateral prophylactic repair of asymptomatic PAAs. DATA COLLECTION AND ANALYSIS We collected data on primary and assisted primary patency rates (primary endpoints) as well as operating time, the length of hospital stay, limb salvage and local wound complications (secondary endpoints). We presented results as risk ratio or mean difference with 95% confidence intervals and assessed the certainty of the evidence using GRADE. MAIN RESULTS No new studies were identified for this update. A single RCT with a total of 30 PAAs met the inclusion criteria. There was a low risk of selection bias and detection bias. However, the risks of performance bias, attrition bias and reporting bias were unclear from the study. Despite being an RCT, the certainty of the evidence was downgraded to moderate due to the small sample size, resulting in wide confidence intervals (CIs); only 30 PAAs were randomised over a period of five years (15 PAAs each in the groups receiving endovascular stent graft and undergoing conventional open surgery). The primary patency rate at one year was 93.3% in the endovascular group and 100% in the surgery group (RR 0.94, 95% CI 0.78 to 1.12; moderate-certainty evidence). The assisted patency rate at one year was similar in both groups (RR 1.00, 95% CI 0.88 to 1.13; moderate-certainty evidence). There was no clear evidence of a difference between the two groups in the primary or assisted patency rates at four years (13 grafts were patent from 15 PAA treatments in each group; RR 1.00, 95% CI 0.76 to 1.32; moderate-certainty evidence); the effects were imprecise and compatible with the benefit of either endovascular stent graft or surgery or no difference. Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) -3.40 days, 95% CI -4.42 to -2.38; P < 0.001; moderate-certainty evidence). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD -119.90 minutes, 95% CI -137.71 to -102.09; P < 0.001; moderate-certainty evidence). Limb salvage was 100% in both groups. Data on local wound complications were not published in the trial report. AUTHORS' CONCLUSIONS Evidence to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs is limited to data from one small study. At one year there is moderate-certainty evidence that primary patency may be improved in the surgery group but assisted primary patency rates were similar between groups. At four years there was no clear benefit from either endovascular stent graft or surgery to primary or assisted primary patency (moderate-certainty evidence). As both operating time and hospital stay were reduced in the endovascular group (moderate-certainty evidence), it may represent a viable alternative to open repair of PAA. A large multicenter RCT may provide more information in the future. However, difficulties in recruiting enough patients are likely, unless it is an international collaboration including a number of high volume vascular centres.
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Affiliation(s)
- Dhiraj Joshi
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Yuri Gupta
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Bhaskar Ganai
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
| | - Chloe Mortensen
- Brighton and Sussex University Hospitals NHS TrustDepartment of Interventional RadiologyEastern RoadBrightonUKBN2 5BE
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Aragão JA, de Miranda FGG, Aragão ICS, Aragão FMS, Reis FP. Treatment of bilateral popliteal artery aneurysms. J Vasc Bras 2019; 19:e20180142. [PMID: 31839798 PMCID: PMC6900880 DOI: 10.1590/1677-5449.180142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery aneurysms are the most frequent type of peripheral aneurysm, accounting for 85% of the all of these aneurysms. Usually asymptomatic, they are generally diagnosed during clinical examination. Incidence is higher among males and seniors. They are bilateral in 50% of the cases and 60% are associated with abdominal aortic aneurysms. This paper describes a 72-year-old male patient who presented with two bilateral pulsatile masses, one in each popliteal region, was otherwise asymptomatic, and had a history of hypertension and dyslipidemia. Clinical examination and ultrasound imaging confirmed a diagnosis of bilateral aneurysms of the popliteal arteries. Popliteal artery aneurysms can be treated with open bypass surgery, with or without aneurysm resection, or with endovascular surgery. This Therapeutic Challenge discusses these possibilities.
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Affiliation(s)
- José Aderval Aragão
- Universidade Federal de Sergipe - UFS, Aracaju, SE, Brasil.,Universidade Tiradentes - UNIT, Aracaju, SE, Brasil
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10
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Chung CTY, Ko H, Kim HK, Mo H, Han A, Ahn S, Min S, Min SK. Thrombosis of a Long-Segment Aneurysm from the Iliac to Popliteal Artery Associated with Arteriovenous Malformation and Varicose Veins. Vasc Specialist Int 2019; 35:165-169. [PMID: 31620403 PMCID: PMC6774428 DOI: 10.5758/vsi.2019.35.3.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old male patient with severe claudication due to thrombosis of the left ilio-femoro-popliteal artery aneurysm. He also had a venous stasis ulcer with a history of multiple embolotherapy of arteriovenous malformation. Duplex sonography revealed reflux and varicose veins of the left great saphenous vein (GSV). A sequential bypass surgery was performed that consisted of excision of the left external iliac and common femoral artery aneurysm, external iliac to deep femoral interposition with an expanded polytetrafluoroethylene graft, and femoro-posterior tibial artery bypass with the reversed left GSV. Symptoms of claudication were alleviated and the chronic ulcer was healed in time. To our knowledge, this is the first report of successful bypass in a patient with arterial aneurysm, arteriovenous malformation, and venous insufficiency that can be diagnosed as an atypical case of Parkes Weber syndrome. Long-term follow-up is needed to define the fate of aneurysms and varicose vein graft.
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Affiliation(s)
| | - Hyunmin Ko
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Kee Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyejin Mo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Popliteal artery aneurysms (PAAs) are the most common peripheral artery aneurysms. They are frequently symptomatic and are associated with high rates of morbidity and limb loss. PAA can be treated by open or endovascular means, although there are no specified recommendations guiding treatment choice. This article delineates many of the differences between open and endovascular repair of asymptomatic PAA, and highlights several key articles comparing open and endovascular repair to guide decision making. Proper diagnosis and choice of repair can lead to good outcomes in the treatment of asymptomatic PAA.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of General Surgery, Yale University, New Haven, Connecticut
| | - Bauer E Sumpio
- Division of Vascular Surgery, Department of General Surgery, Yale University, New Haven, Connecticut
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12
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Dilating Vascular Diseases: Pathophysiology and Clinical Aspects. Int J Vasc Med 2018; 2018:9024278. [PMID: 30225143 PMCID: PMC6129317 DOI: 10.1155/2018/9024278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/29/2018] [Indexed: 01/22/2023] Open
Abstract
Atherosclerotic disease of the vessels is a significant problem affecting mortality and morbidity all over the world. However, dilatation of the vessels either in the arterial system or in the venous territory is another vessel disease. Varicocele, pelvic, and peripheral varicose veins and hemorrhoids are aneurysms of the venous vascular regions and have been defined as dilating venous disease, recently. Coronary artery ectasia, intracranial aneurysm, and abdominal aortic aneurysm are examples of arterial dilating vascular diseases. Mostly, they have been defined as variants of atherosclerosis. Although there are some similarities in terms of pathogenesis, they are distinct from atherosclerotic disease of the vessels. In addition, pathophysiological and histological similarities and clinical coexistence of these diseases have been demonstrated both in the arterial and in the venous system. This situation underlies the thought that dilatation of the vessels in any vascular territory should be considered as a systemic vessel wall disease rather than being a local disease of any vessel. These patients should be evaluated for other dilating vascular diseases in a systematic manner.
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Cousins RS, Dexter DJ, Ahanchi SS, Cain BC, Powell OM, Ongstad SB, Parikh NM, Panneton JM. Determining patient risk factors associated with accelerated growth of popliteal artery aneurysms. J Vasc Surg 2018; 67:838-847. [DOI: 10.1016/j.jvs.2017.07.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022]
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Bandeira RN, Cacione DG, Bandeira FCV, Pelissoni ADS, Leite CON, Nakano LCU. Tratamento endovascular versus tratamento aberto de aneurisma de artéria poplítea: artigo de revisão. J Vasc Bras 2018; 17:34-41. [PMID: 29930679 PMCID: PMC5990263 DOI: 10.1590/1677-5449.004917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O tratamento convencional do aneurisma da artéria poplítea é a cirurgia aberta de exclusão do aneurisma e revascularização do membro acometido. Nos últimos anos, o tratamento endovascular vem ganhando popularidade e interesse. O tratamento endovascular é menos invasivo e de menor morbidade; porém, é de alto custo e sua perviedade é incerta. O objetivo desta revisão é comparar os dois tratamentos através da análise de desfechos abordados em estudos primários e secundários. Realizou-se uma revisão narrativa da literatura publicada nos últimos 5 anos. Foram selecionados seis estudos retrospectivos, duas metanálises, um ensaio clínico e uma revisão sistemática Cochrane. Número limitado de pacientes e curto período de seguimento não nos permitem extrair conclusões consistentes. Não há evidência clara que sugere melhores resultados entre um ou outro tratamento eletivo. Novos ensaios randomizados devem ser realizados para determinar o papel do tratamento endovascular desse aneurisma.
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Affiliation(s)
| | - Daniel Guimarães Cacione
- Universidade Federal de São Paulo - UNIFESP, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
| | | | | | | | - Luis Carlos Uta Nakano
- Universidade Federal de São Paulo - UNIFESP, Departamento de Cirurgia Vascular e Endovascular, São Paulo, SP, Brasil
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Giaquinta A, Veroux P, D'Arrigo G, Virgilio C, Ardita V, Mociskyte D, Veroux M. Endovascular Treatment of Chronic Occluded Popliteal Artery Aneurysm. Vasc Endovascular Surg 2016; 50:16-20. [PMID: 26912525 DOI: 10.1177/1538574415627870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Critical limb ischemia may be the consequence of chronic occlusion of an aneurysm of popliteal artery. Endovascular repairs have the potential to be less invasive than open surgery and to allow the treatment, during the same procedure, of occlusive infrapopliteal diseases achieving a better distal outflow. Eleven patients with occluded popliteal artery aneurysm (PAA) underwent an endovascular repair of PAA using a new technique, by positioning of a Viabahn graft inside a bare nitinol stent, deployed at the level of aneurysm with the intent to avoid distal embolization and to assure an external scaffold for the Viabahn graft. Immediate success rate was 100%. A peroneal artery embolization occurred in 1 patient (9%) and was successfully treated by stent implantation. Four (36.4%) patients needed a below-the-knee revascularization to achieve at least 1 vessel line to the foot. Mean postoperative hospital stay was 2.6 days. At 24-month follow-up, primary patency, target lesion revascularization, and major amputation rates were 82%, 9%, and 0%, respectively. All patients are still alive at last follow-up visit. The endovascular repair with the combined use of a bare metal stent and Viabahn graft resulted in a low incidence of distal embolization and major amputation rate, with an excellent 24-month patency rate, and may offer a safe alternative to open surgery for the treatment of occluded PAAs.
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Affiliation(s)
- Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Giuseppe D'Arrigo
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Carla Virgilio
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Vincenzo Ardita
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Dovile Mociskyte
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
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Braga AFF, Catto RC, Ribeiro MS, Piccinato CE, Joviliano EE. Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.02715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.
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Mazzaccaro D, Carmo M, Dallatana R, Settembrini AM, Barbetta I, Tassinari L, Roveri S, Settembrini PG. Comparison of posterior and medial approaches for popliteal artery aneurysms. J Vasc Surg 2015; 62:1512-20. [DOI: 10.1016/j.jvs.2015.06.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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Speziale F, Sirignano P, Menna D, Capoccia L, Mansour W, Serrao E, Ronchey S, Alberti V, Esposito A, Mangialardi N. Ten Years' Experience in Endovascular Repair of Popliteal Artery Aneurysm Using the Viabahn Endoprosthesis: A Report from Two Italian Vascular Centers. Ann Vasc Surg 2015; 29:941-9. [DOI: 10.1016/j.avsg.2015.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
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Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair. J Vasc Surg 2015; 61:663-9. [DOI: 10.1016/j.jvs.2014.09.069] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022]
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Comparison of popliteal artery aneurysm therapies. J Vasc Surg 2015; 61:655-61. [DOI: 10.1016/j.jvs.2014.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/05/2014] [Indexed: 11/22/2022]
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Eslami MH, Doros G, Goodney PP, Elderup-Jorgenson J, Cronenwett JL, Malikova M, Farber A. Using vascular quality initiative as a platform for organizing multicenter, prospective, randomized clinical trials: OVERPAR trial. Ann Vasc Surg 2014; 29:278-85. [PMID: 25311746 DOI: 10.1016/j.avsg.2014.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/31/2014] [Accepted: 08/10/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND We describe the organization of a prospective, randomized, multicenter trial comparing the effectiveness of open popliteal artery aneurysm repair (OPAR) and endovascular popliteal artery aneurysm repair (EPAR) of asymptomatic popliteal artery aneurysms (PAAs) as an example for how to use the Vascular Quality Initiative (VQI) framework. Given that many centers participate in the VQI, this model can be used to perform multicenters' prospective trials on very modest budget. METHODS VQI prospectively collects data on many vascular procedures. These data include many important perioperative, intraoperative, and postoperative details regarding both patients and their procedures. We describe a study where minimal changes to the collected data by participating centers can provide level-1 evidence regarding a significant clinical question. Data will be collected using modified VQI forms within the existing VQI data reporting structure. We plan to enroll 148 patients with asymptomatic PAAs into the open and endovascular surgery cohorts. Patients from participating VQI centers will be randomized 1:1 to either OPAR or EPAR and will be followed for an average of 2.5 years. Our primary hypothesis is that major adverse limb event-free survival is lower in the EPAR cohort and that EPAR is associated with more secondary interventions, improved quality of life, and decreased length of stay. The budget for this trial is fixed at $10,000/year for the course of the study, and the trial is judged to be feasible because of the functionality of the VQI platform. CONCLUSIONS Using the existing VQI infrastructure, Open versus Endovascular Repair of Popliteal Artery Aneurysm will provide level 1 data for PAA treatment on a modest budget. The proposed trial has an adequately powered comparative design that will use objective performance goals to describe limb-related morbidity and procedural reintervention rates.
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Affiliation(s)
- Mohammad H Eslami
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA.
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Philip P Goodney
- Division of Vascular and Endovascular Surgery, Dartmouth School of Medicine, Lebanon, NH
| | | | - Jack L Cronenwett
- Division of Vascular and Endovascular Surgery, Dartmouth School of Medicine, Lebanon, NH
| | - Marina Malikova
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA
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Dorweiler B, Gemechu A, Doemland M, Neufang A, Espinola-Klein C, Vahl CF. Durability of open popliteal artery aneurysm repair. J Vasc Surg 2014; 60:951-7. [DOI: 10.1016/j.jvs.2014.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/10/2014] [Indexed: 11/26/2022]
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Giant popliteal artery aneurysm: case report and review of the literature. Case Rep Vasc Med 2014; 2014:780561. [PMID: 25221686 PMCID: PMC4158144 DOI: 10.1155/2014/780561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/01/2014] [Indexed: 12/04/2022] Open
Abstract
Popliteal artery aneurysms (PAAs) are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm, inflammatory arteritis, or popliteal entrapment are responsible. The authors report the first ever case of a male diagnosed with chronic renal failure with giant popliteal artery aneurysm. We have successfully resected the aneurysm and revascularized with synthetic graft.
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Abstract
BACKGROUND Popliteal artery aneurysm (PAA) is a focal dilatation and weakening of the popliteal artery. If left untreated, the aneurysm may thrombose, rupture or the clot within the aneurysm may embolise causing severe morbidity. PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. The success of the procedure is gauged by the ability of the graft to stay patent over an extended duration. While surgical treatment is usually preferred in an emergency, the evidence on first line treatment in a non-emergency setting is unclear. OBJECTIVES To assess the effectiveness of an endovascular stent graft versus conventional open surgery for the treatment of asymptomatic popliteal artery aneurysms (PAA) on primary and assisted patency rates, hospital stay, length of the procedure and local complications. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched their Specialised Register (last searched June 2014) and CENTRAL (2014, Issue 5). Clinical trials databases were searched for any ongoing or unpublished studies. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing endovascular stent grafting versus conventional open surgical repair in patients undergoing unilateral or bilateral prophylactic repair of asymptomatic PAAs were included. DATA COLLECTION AND ANALYSIS Data were collected on primary and secondary patency rates (primary endpoints) as well as operating time, the length of hospital stay, limb salvage and local wound complications (secondary endpoints). MAIN RESULTS A single RCT was identified that conformed to the inclusion criteria. There was a low risk of selection bias and detection bias. However, the risks of performance bias, attrition bias and reporting bias were unclear from the study. Despite being an RCT, the level of evidence was downgraded to moderate due to the small sample size, resulting in wide confidence intervals (CIs); only 30 PAAs were randomised over a period of five years (15 PAAs each in the groups receiving endovascular stent graft and undergoing conventional open surgery). The primary patency rate at one year was 100% in the surgery group and 93.3% in the endovascular group (P = 0.49). However, the assisted patency rate at one year was similar in both groups (100% patency). There was no clear evidence of a difference between the two groups in the primary or secondary patency rates at four years (13 grafts were patent from 15 PAA treatments in each group). However, the effects were imprecise and compatible with the benefit of either endovascular stent graft or surgery or no difference. Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) -3.40 days, 95% CI -4.42 to -2.38; P < 0.001). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD -119.20 minutes, 95% CI -137.71 to -102.09; P < 0.001). Limb salvage was 100% in both groups. Data on local wound complications were not published in the trial report. AUTHORS' CONCLUSIONS Due to the limitations of the current evidence from one small underpowered study, we are unable to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs. A larger ongoing multicentre RCT should provide more information in the future. However, it seems reasonable to suggest that endovascular repair should be considered as a viable alternative to open repair of PAA on a case by case basis.
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Affiliation(s)
- Dhiraj Joshi
- Department of Clinical Radiology, Royal Sussex County Hospital, Eastern Road, Brighton, UK, BN2 5BE
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Ahmed Z, Desai M, Grewal PS, Hamilton G. Operative technique for the treatment of popliteal artery aneurysms. Hippokratia 2014. [DOI: 10.1002/14651858.cd011238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zubir Ahmed
- Guy's and St Thomas' NHS Foundation Trust; General and Transplant Surgery; Level 3, Borough Wing, Guy's Hospital Great Maze Pond London UK SE1 9RT
| | - Mital Desai
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
| | - Perbinder S Grewal
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
| | - George Hamilton
- Royal Free London NHS Foundation Trust; Department of Vascular Surgery; Pond Street London UK NW3 2QG
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Coskun I, Demirturk OS, Tunel HA, Andic C, Gulcan O. Positive clinical outcomes of the saphenous vein interposition technique for ruptured popliteal artery aneurysm. Surg Today 2014; 44:1674-7. [DOI: 10.1007/s00595-014-0891-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
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Taurino M, Filippi F, Ficarelli R, Fantozzi C, Dito R, Brancadoro D, Rizzo L. Different approaches in popliteal artery aneurysm management. Eur Surg 2013. [DOI: 10.1007/s10353-013-0221-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dawson J, Fitridge R. Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger? Prog Cardiovasc Dis 2013; 56:26-35. [PMID: 23993236 DOI: 10.1016/j.pcad.2013.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.
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Affiliation(s)
- Joe Dawson
- Discipline of Surgery, University of Adelaide, and Vascular Unit, The Queen Elizabeth Hospital, Adelaide, Australia
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Stone PA, Jagannath P, Thompson SN, Campbell JE, Mousa AY, Knackstedt K, Hass SM, AbuRahma AF. Evolving treatment of popliteal artery aneurysms. J Vasc Surg 2013; 57:1306-10. [DOI: 10.1016/j.jvs.2012.10.122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/26/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
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Results of elective and emergency endovascular repairs of popliteal artery aneurysms. J Vasc Surg 2013; 57:1299-305. [PMID: 23375609 DOI: 10.1016/j.jvs.2012.10.112] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). METHODS This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. RESULTS EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P = .14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P = .56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P = .15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. CONCLUSIONS These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.
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Plaza-Martínez Á, Ortiz-Monzón E, Gómez-Palonés FJ, Genovés-Gascó B, Martínez-Perelló I, Martínez-Parreño C. Popliteal Artery Aneurysm in Patient With Klippel–Trénaunay–Weber Syndrome. Ann Vasc Surg 2011; 25:838.e13-6. [DOI: 10.1016/j.avsg.2010.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 11/30/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
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Cross JE, Galland RB. Part one: For the motion asymptomatic popliteal artery aneurysms (less than 3 cm) should be treated conservatively. Eur J Vasc Endovasc Surg 2011; 41:445-8; discussion 449. [PMID: 21453861 DOI: 10.1016/j.ejvs.2011.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J E Cross
- Department of Surgery, Royal Berkshire Hospital, London Road, Reading, Berkshire RG1 5AN, UK
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Cross JE, Galland RB, Hingorani A, Ascher E. Nonoperative versus surgical management of small (less than 3 cm), asymptomatic popliteal artery aneurysms. J Vasc Surg 2011; 53:1145-8. [PMID: 21439460 DOI: 10.1016/j.jvs.2011.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Popliteal artery aneurysms represent a common pathology that vascular surgeons are often confronted with. However, several issues remain incompletely understood, including indications for intervention and optimal methods of treatment. In the following article, our discussants debate the appropriate management of small popliteal artery aneurysms. Further complicating this discussion is the unclear relationship between popliteal artery aneurysm diameter and subsequent complications. Whereas with abdominal aortic aneurysms diameter is linked to rupture risk, it is less clear with popliteal artery aneurysms where complications are more likely to include thrombosis, embolization, and compression whether aneurysm diameter is accurately predictive. Perhaps other anatomic features should be included in our management algorithms? Regardless, our debaters will try to convince us whether small popliteal artery aneurysms warrant repair or not.
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Affiliation(s)
- Jane E Cross
- Department of Surgery, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
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Etezadi V, Fuller J, Wong S, Pena C, Benenati JF, Diehm N, Patel RS, Katzen BT. Endovascular Treatment of Popliteal Artery Aneurysms: A Single-center Experience. J Vasc Interv Radiol 2010; 21:817-23. [DOI: 10.1016/j.jvir.2010.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 01/07/2010] [Accepted: 01/19/2010] [Indexed: 11/24/2022] Open
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Open versus endovascular repair of popliteal artery aneurysms. J Vasc Surg 2010; 51:271-6. [PMID: 20117505 DOI: 10.1016/j.jvs.2009.09.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
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Lovegrove R, Javid M, Magee T, Galland R. Endovascular and Open Approaches to Non-thrombosed Popliteal Aneurysm Repair: A Meta-analysis. Eur J Vasc Endovasc Surg 2008; 36:96-100. [PMID: 18396427 DOI: 10.1016/j.ejvs.2008.02.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 02/04/2008] [Indexed: 11/25/2022]
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