Outcomes of Open and Endovascular Repair of Popliteal Artery Aneurysm
Akiko Tanaka, Yuki Ikeno, Naveed U Saqib, Gordon H Martin, Harleen K Sandhu, Charles C Miller, III, Hazim J Safi, Kourosh Keyhani, Arash Keyhani
McGovern Medical School at UTHealth, Houston, TX
INTRODUCTION: We report early and mid-term outcomes of open surgical repair (OSR) and Endovascular repair (EVR) of popliteal artery aneurysms.
METHODS: This is a single-center study included all consecutive patient treated for popliteal artery aneurysms during the period of January 2010 to Decemeber 2020. A total of 73 limbs in 66 patients underwent interventions for popliteal artery aneurysm at our institutions. Of 73, 5 limbs were non-salvageable at the time of presentation and had immediate amputation, and these limbs were excluded from the study. Patient demographics, intraoperative data, and outcomes were retrospectively reviewed.
RESULTS: 46 popliteal artery aneurysms were repaired with OSR and 22 limbs with EVR. Of 68 popliteal artery aneurysms, 12 repairs (18%) were emergent (22% of OSR and 9% of EVR, p=0.311). All patients underwent EVR were treated with a Viabahn® covered stent graft (W. L. Gore & Assoc, Inc, Flagstaff, AZ). Among 46 OSR repairs, 44 received bypass and 2 had thrombectomy with aneurysmorraphy. Median age was significantly younger in the OSR group (OSR, median 69 years, Interquartile range [IQR]: 60 - 75 years vs. EVR, median 74 years, IQR 68 - 78 years, P=0.004). EVR group had significantly higher incidence of chronic obstructive pulmonary disease (OSR, 11% vs. EVR 41%, P=0.008). EVR group had good distal run-offs (2 or 3 vessel run-offs) compared to the OSR group (OSR, 32 of 41 [5 popliteal artery aneurysm with unreported for run-offs] vs. EVR 22 of 22; P=0.021). Length of hospital stay was significantly longer in OSR group (OSR, median 4 days, IQR 2 - 6 days vs. EVR, median 1, IQR 0 - 2 days; P<0.001) Survival rates at 5-year were 92.9% ± 4.0% in OSR group and 91.7% ±8.0% in EVR (P=0.381). Primary patency rates at 5-year were similar in two groups (OSR, 80.8 ± 6.2 vs. EVR, 78.7% ±11.6%; p=0.0387). Amputation-free survival rates at 5-year were 81.6% ± 5.9% in OSR and 67.5% ± 14.0% in EVR, which were similar between the groups (P=0.854). Acute limb ischemia requiring emergent surgery and poor distal run-off was a predictor for amputation.
CONCLUSIONS: Both OSR and EVR provides durable and satisfactory outcomes after popliteal artery repair with appropriate target selection. i
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