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Late Longitudinal Comparison of Endovascular and Open Popliteal Aneurysm Repairs

Published:September 10, 2015DOI:https://doi.org/10.1016/j.avsg.2015.07.012

      Background

      We sought to define suitable anatomy predicting durable exclusion of popliteal artery aneurysms (PAAs) and define optimal patient selection criteria for endovascular repair (ER).

      Methods

      Seventy-five PAAs were repaired in 66 patients (64 male and 2 female) over the past 13 years. Fifty-two aneurysms (69%) were treated with open surgical exclusion and/or bypass using autologous vein (69%) or polytetrafluorethylene (31%) conduit. Extended bypass targets required inflow from the common femoral artery in 15% of limbs and outflow via a tibial artery in 31%. Since May 2001, ER was considered in patients with high medical risk, limited vessel tortuosity, absence of significant occlusive disease (ankle-brachial index > 0.9), and PAA not involving below knee segments. Interventions were performed via antegrade femoral access in 23 limbs (31%) using commercially available endografts. Device diameters ranged between 7 and 13 mm, with a median of 2 devices per PAA, and mean treatment length was 22 cm (range, 5–36 cm). All patients were followed with duplex ultrasound surveillance and were prescribed clopidogrel and/or aspirin.

      Results

      Patients treated endovascularly were older (82 vs. 70 years old, P = 0.01), but had shorter length of stay (2 vs. 12 days, P = 0.01) and lower complication rates (8% vs. 17%, P = 0.02). Mean surveillance interval was 39 months with similar 4-year survival (67.9% open and 73.7% endovascular). Primary and secondary patencies were 67.2%, 67.2% after ER and 65.5%, 78.4% for open at 4 years, respectively. Four of 6 endovascular failures were thrombosis within 4 months of intervention and had conversions to open repair (OR). Secondary interventions were required after 48.1% of endovascular and 54.1% of ORs. Three limbs were lost in the series (2 open and 1 endovascular).

      Conclusions

      Similar outcomes can be expected after endovascular and open PAA repair with adherence to specific anatomic and technical selection requisites.
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