Factors Affecting Outcome After Endovascular Repair (EVPAR) of Popliteal Artery Aneurysms (PAAs)

Abstract

To analyze factors affecting outcome after EVPAR. Clinical data of consecutive PAA patients treated with EVPAR (2000-2012) were reviewed. Primary endpoints were major adverse events: mortality, thrombosis, amputation, complications, reinterventions. EVPAR was performed in 46 limbs, 38 patients, elective: 33 (72%), emergent: 13 (28%). One aneurysm ruptured, 12 caused acute ischemia (12 underwent thrombolysis+ EVPAR). Mean of 2.0 Viabahn® stent-grafts (range, 1-4) were used. Sixteen procedures (35%) were performed percutaneously, 30 through femoral cutdown. Technical success was 98%. Thirty-day mortality was 4.4%, all after emergencies (15.4%, 2/13). Thirty-day primary and secondary patencies were 100% for elective, 75% and 84%, respectively for emergencies. Two major amputations (15.4%) were done after emergent EVPAR. Early complications were more frequent after emergencies (77% vs 12%; P < .0001). Intracranial hemorrhage occurred in one patient (2.2%). Mean follow-up was 2.2 years (30 days-8.6 years). At 2 years, primary patencies were 70% and 64% (P = .44), secondary patencies 80% and 84%, (P = .79); no limb was lost in elective cases, limb salvage was 84% for emergencies (P = .02); reinterventions were similar (19% and 30%); major adverse events occurred after 20 procedures (44%) (elective, 38%; emergent, 64%; P = .01). There were 5 conversions (elective, 4; emergent, 1). Factors affecting adverse events included emergent EVPAR and percutaneous placement. PAA with acute presentation continues to have elevated mortality (16%) and limb loss (16%). Although elective EVPAR has excellent early results, 2-year patency of 80% remains a concern.