Advertisement

Outcomes of Popliteal Endarterectomy and Infrapopliteal Angioplasty for Short Atherosclerotic Popliteal Artery Occlusion: Single-Center Case Series

  • Aram Baram
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq
    Search for articles by this author
  • Abdulsalam Yaseen Taha
    Correspondence
    Correspondence to: Abdulsalam Yaseen Taha, Department of Thoracic and Cardiovascular Surgery, College of Medicine, P O Box 1155/64, Mamostayan Street 112, Road 33, House 5, Sulaimaniyah 46001, Iraq
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq
    Search for articles by this author
  • Rzgar Ghareeb Muhamed
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Sulaymaniyah Teaching Hospital, Sulaymaniyah, Region of Kurdistan, Iraq
    Search for articles by this author

      Background

      Localized popliteal artery occlusion (LPAO) is a rare entity with a challenging therapy. In selected patients, open popliteal endarterectomy (OPE) with infrapopliteal balloon angioplasty (IPA) can be limb-saving. The aim of this retrospective study from Iraq-Kurdistan is to assess the procedure outcomes.

      Methods

      Over 5 years, ending at 2020, 28 patients with atherosclerotic LPAO unsuitable for femoropopliteal bypass or endovascular intervention received OPE + IPA through a medial approach under spinal anesthesia. Perioperative data were obtained from patients’ records and entered into an Access database. Results were retrieved and statistically analyzed.

      Results

      There were 18 (64.3%) males. The mean age was 66.4 ± 6.53 years (range 52–79 years). Seventy five percent of patients had obesity, diabetes mellitus, and smoking. Twenty six (92.9%) of patients were in Rutherford category 5 and 6 with an ankle-brachial index < 0.40. Popliteal and pedal pulses were absent in 23 of 24 (95.8%) patients. Doppler ultrasound showed a good distal runoff in 1 (3.6%) patient. Computed tomography angiography revealed 20 (71.4%) femoropopliteal and 16 (57.1%) infrapopliteal lesions of types A and B as per Trans-Atlantic Inter-Society Consensus II document. Mean endarterectomy length was 5.1 cm (range 3–7), patched with a vein in (17, 60.7%) and primarily closed in (11, 39.3%) patients. Early complications were none in (18, 64.3%) patients whereas 1 leg was amputated on day 30. On average, follow-up lasted 3.4 years. Twenty seven (96.4%) vessels remained patent and 2 (7.1%) patients died.

      Conclusions

      Our study confirms safety and efficacy of OPE + IPA for selected patients with critical limb ischemia due to LPAO.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Argueta E.E.
        • Rosales A.
        • Suarez J.A.
        A retrospective analysis of laser endartherectomy assisted balloon angioplasty for popliteal and infrapopliteal peripheral arterial disease.
        Int J Cardiol. 2016; 225: 87-90
        • Nasr H.
        • Hobbs S.
        • Abrew C.
        Popliteal endarterectomy for localized popliteal artery disease.
        Ann Vasc Surg. 2015; 29: 50-54
        • SANTOS J.D.O.S.
        Note on the depopulation of old arterial thromboses.
        Mem Acad Chir. 1947; 73: 409-411
        • Abbas M.
        • Claydon M.
        • Ponosh S.
        • et al.
        Open endarterectomy of the SPT segment: an experience.
        Ann Vasc Surg. 2007; 21: 39-44
        • Agha R.A.
        • Borrelli M.R.
        • Farwana R.
        • et al.
        The PROCESS 2018 statement: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines.
        Int J Surg. 2018; 60: 279-282
        • Stoner M.C.
        • Calligaro K.D.
        • Chaer R.A.
        • et al.
        Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease.
        J Vasc Surg. 2016; 64: e1-e21
        • Aboyans V.
        • Criqui M.H.
        • Abraham P.
        • et al.
        Measurement and interpretation of the ankle-brachial index: a scientific statement from the American heart association.
        Circulation. 2012; 126: 2890-2909
        • Norgren L.
        • Hiatt W.R.
        • Dormandy J.A.
        • et al.
        Inter-society consensus for the management of peripheral arterial disease.
        Int Angiol. 2007; 26: 81-157
        • Jaff M.R.
        • White C.J.
        • Hiatt W.R.
        • et al.
        An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II).
        Vasc Med. 2015; 20: 465-478
        • Wright L.B.
        • Matchett W.J.
        • Cruz C.P.
        • et al.
        Popliteal artery disease: diagnosis and treatment.
        Radiographics. 2004; 24: 467-479
        • Kok H.K.
        • Asadi H.
        • Sheehan M.
        • et al.
        Outcomes of infrapopliteal angioplasty for limb salvage based on the updated TASC II classification.
        Diagn Interv Radiol. 2017; 23: 360-364
        • Mirza A.J.
        • Mohammed N.A.
        • Taha A.Y.
        • et al.
        Below-the-Knee Intervention for Ischemic Diabetic Foot in Kurdistan, Iraq: A Case-Control Study.
        Ann Vasc Surg. 2021; 72: 535-543
        • Taha Abdulsalam Y.
        • Nazar Q.
        • Sheikho A.S.Y.
        Femoropopliteal bypass for chronic lower limb ischemia: review of 48 cases.
        Basra J Surg. 2015; 21: 56-64
        • Baram A.
        • Abdullah T.N.
        • Taha A.Y.
        Femoropopliteal bypass for chronic lower limb ischemia: a prospective cohort study and single center cases series.
        Int J Surg Open. 2019; 21: 1-6
        • Kumar N.
        • Verma R.K.
        • Krishna V.
        Open endarterectomy in short atherosclerotic occlusion of the popliteal artery.
        Indian J Thorac Cardiovasc Surg. 2013; 29: 230-234
        • van der Heijden F.H.W.M.
        • Eikelboom B.C.
        • van Reedt Dortland R.W.H.
        • et al.
        Long-term results of semiclosed endarterectomy of the superficial femoral artery and the outcome of failed reconstructions.
        J Vasc Surg. 1993; 18: 271-279
        • Lin Peter H.
        • Mun Jye Poi J.M.
        • Kougias Panagiotis
        • et al.
        Arterial disease.
        in: Brunicardi F.C. Schwartz’s Principles of Surgery. 10th ed. McGraw Hill Education, New York, Chicago, San Francisco, Athens, London, Madrid, Mexico City, Milan, New Delhi, Singapore, Sydney and Toronto2015
        • Magnitskiy L.A.
        • Kuznetsov M.R.
        • Sapelkin S.V.
        Posterior approach popliteal artery endarterectomy combined with above knee bypass versus below knee bypass surgery for long occlusions of the superficial and popliteal arteries: long-term results.
        Eur J Vasc Endovasc Surg. 2019; 58: e451
        • Okuda H.
        • Kikuchi S.
        • Koya A.
        • et al.
        A case of isolated infragenicular arterial lesions successfully treated with open endarterectomy.
        Ann Vasc Dis. 2021; 14: 79-82
        • Iscan S.
        • Cakir H.
        • Yurekli I.
        • et al.
        Graft materials for popliteal artery patch plasty.
        Ann Vasc Surg. 2015; 29: 1483-1484
        • Singh N.
        • Ding L.
        • Devera J.
        • et al.
        Prescribing of statins after lower extremity revascularization procedures in the US.
        JAMA Netw open. 2021; 4: e2136014
        • Zierler R.E.
        • Jordan W.D.
        • Lal B.K.
        • et al.
        The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures.
        J Vasc Surg. 2018; 68: 256-284