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

      Abstract

      Objectives

      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). 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 one (3.6%) patient. CT angiography revealed 20 (71.4%) femoropopliteal and 16 (57.1%) infrapopliteal lesions of types A and B as per TASC 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 one leg was amputated on day 30. On average, follow-up lasted 3.4 years. Twenty-seven (96.4%) vessels remained patent and two (7.1%) patients died.

      Conclusions

      Our study confirms safety and efficacy of OPE+IPA for selected patients with critical limb ischemia due to LPAO.

      Keywords

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