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Less patency, fewer complications for endovascular approach to popliteal artery aneurysm repair
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HOLLYWOOD, Fla. — Compared with open surgery, endovascular popliteal artery aneurysm repair was associated with lower patency but fewer complications, according to results of a retrospective single-center study presented at the International Symposium on Endovascular Therapy.
Researchers evaluated all patients who underwent popliteal artery aneurysm repair with an endovascular graft (Viabahn, W.L. Gore) or reverse saphenous vein grafting at the Cleveland VA hospital between 2000 and 2012.
Ji Y. Buethe
“Open repair bypass surgery has been considered the gold standard for popliteal artery aneurysms, with limb salvage rates of up to 90%,” Ji Y. Buethe, MD, chief resident at University Hospitals Case Medical Center, Cleveland, said during a presentation. “With advancements in endovascular therapy, [popliteal artery aneurysm] exclusion with an endovascular stent graft has emerged as a possible alternative.”
The study covered 18 patients (mean age, 66 years; 100% men) and 23 limbs (13 open surgery repair, 9 endovascular repair). The outcomes of interest were primary patency, assisted primary patency, secondary patency and major complications. Mean follow-up was 53.3 months for the open-repair group and 8.9 months for the endovascular group.
Of the 23 repairs, five were done on an emergency basis and the rest on an elective basis. All but one of the emergency repairs were performed with open surgery.
Demographics analysis demonstrated overall higher prevalence of medical comorbidities in the endovascular group. There were no differences between the groups in aneurysm characteristics, and technical success was 100%, Buethe said.
Among the 16 limbs that had preoperative angiograms, mean number of patent runoff vessels was 2.2 in the open-surgery group and 2 in the endovascular group, according to the researchers.
At the end of follow-up, primary patency was 73% in the open-surgery group vs. 66% in the endovascular group (P = .45), while assisted primary patency was 89% in the open-surgery group and 85% in the vascular group (P = .82) and secondary graft patency was 100% in both groups, Buethe said.
However, significant complications were observed in 23% of the open-surgery group vs. none of the endovascular group (P = .04). Buethe noted that there were two deaths in the open-repair group, but they were not associated with complications from the procedure.
“Endovascular therapy for [popliteal artery aneurysms] can be a valuable option for a larger patient population, not just limited to a high-risk patient population,” she said. – by Erik Swain
Reference:
Buethe JY, et al. Concurrent Session I: Peer-Reviewed Abstracts. Presented at: International Symposium on Endovascular Therapy; Feb. 6-10, 2016; Hollywood, Fla.
Disclosure: Buethe reports no relevant financial disclosures.