Long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair.

Abstract

OBJECTIVES:

The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair (EVPAR).

METHODS:

This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan-Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis.

RESULTS:

Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases (n = 43) the procedure was elective, while in 7% of cases it was for rupture (n = 2) or acute thrombosis (n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p < .001). Segment coverage >20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p = .032).

CONCLUSIONS:

EVPAR provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure.

• Authors: M Piazza, M Menegolo, A Ferrari, S Bonvini, J J Ricotta, P Frigatti, F Grego, M Antonello
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 48 Issue 2 Pg. 161-8 (Aug 2014) ISSN: 1532-2165 [Electronic] England
• PMID: 24913684 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aneurysm (diagnosis, mortality, physiopathology, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects, mortality)
• Elective Surgical Procedures
• Emergencies
• Endovascular Procedures (adverse effects, mortality)
• Female
• Humans
• Kaplan-Meier Estimate
• Limb Salvage
• Male
• Middle Aged
• Multivariate Analysis
• Popliteal Artery (diagnostic imaging, physiopathology, surgery)
• Postoperative Complications (mortality, surgery)
• Proportional Hazards Models
• Prosthesis Failure
• Reoperation
• Retrospective Studies
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Vascular Patency