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Contemporary outcomes of open and endovascular popliteal artery aneurysm repair
- Source :
- Journal of Vascular Surgery. 63:70-76
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- The purpose of this study was to evaluate contemporary practice and outcomes of open repair (OR) or endovascular repair (ER) for popliteal artery aneurysms (PAAs).Consecutive patients with PAA treated at one institution from January 2006 to March 2014 were reviewed under an Institutional Review Board-approved protocol. Demographics, indications, anatomic characteristics, and outcomes were collected. Standard statistical methods were used.A total of 186 PAAs were repaired in 156 patients (110 ORs, 76 ERs) with a mean age of 71 ± 11 years, and most were male (96%). Mean follow-up was 34.9 ± 28.6 months for OR and 28.3 ± 25.8 months for ER (P = .12). Comorbidities were similar between groups. OR was used in more patients with PAA thrombosis (41.8% vs 5.3%; P.001), acute ischemia (24.5% vs 9.2%; P = .010), and ischemic rest pain (34.5% vs 6.6%; P.001). Mean tibial (Society for Vascular Surgery) runoff score was 5.0 for OR vs 3.3 for ER (P = .006). OR was associated with increased 30-day complications (22% vs 2.6%; P.001) and mean postoperative stay (5.8 vs 1.6 days; P.001). There was no difference in 30-day mortality (OR, 1.8%; ER, 0%; P = .56) or major amputation rate (OR, 3.7%; ER, 1.3%; P = .65). Primary, primary assisted, and secondary patency rates were similar at 3 years (OR, 79.5%, 83.7%, and 85%; ER, 73.2%, 76.3%, and 83%; P = NS). Among 130 patients presenting electively without acute ischemia or thrombosed PAA (63 ORs and 67 ERs), OR had better 3-year primary patency (88.3% vs 69.8%; P = .030) and primary assisted patency (90.2% vs 73.5%; P = .051) but similar secondary patency (90.2% vs 82%; P = .260). ER thrombosis was noted in 8 of 24 patients treated in 2006-2008 (33%; mean time to failure, 49 months) but in only 4 of 51 patients treated in 2009-2013 (7.8%; mean time to failure, 30 months), suggesting a steep learning curve.ER is a safe and durable option for PAA, with lower complication rates and a shorter length of stay. OR has superior primary patency in patients treated electively but no difference in midterm secondary patency and amputations.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Comorbidity
030204 cardiovascular system & hematology
Amputation, Surgical
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Aneurysm
Risk Factors
medicine.artery
medicine
Humans
Vascular Patency
Popliteal Artery
030212 general & internal medicine
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Endovascular Procedures
Retrospective cohort study
Length of Stay
Middle Aged
Pennsylvania
Limb Salvage
medicine.disease
Thrombosis
Popliteal artery
Surgery
Treatment Outcome
Amputation
Elective Surgical Procedures
Female
Cardiology and Cardiovascular Medicine
Complication
business
Vascular Surgical Procedures
Learning Curve
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 63
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....f1c02c65873edd01a83fa2cadef23772