Invited commentary

Abstract

The study by Gloviczki and colleagues documents their extensive experience with the open surgical repair of popliteal artery aneurysms. Despite the usual limitations of a single-center, retrospective study, it provides an exhaustive amount of information and truly represents the gold standard for comparison with the newer endovascular approaches. The study further confirms the well-known male predominance, prevalence of associated aneurysms, patterns of presentations, and favorable surgical outcomes seen in patients with popliteal artery aneurysms. Several predictors of graft failure were identified, including acute/chronic symptoms, poor arterial runoff, distal anastomotic site, and conduit. Unfortunately, the choice of conduit is usually the only factor among these at the discretion of the surgeon. The authors’ excellent results appear to validate their operative indications, particularly among patients with asymptomatic aneurysms (operative indications, asymptomatic [size >2 cm], presence of mural thrombus, or evidence of thromboembolism). The authors conclude that endoaneurysmorrhaphy is superior to proximal/distal ligation on the basis of an observed significant difference in the freedom-from-reintervention rate (100% vs 98%; P = .03). Although I would contend that the observed difference is likely not clinically significant, their conclusion is likely correct given several recent publications documenting aneurysm growth (and compressive symptoms) after ligation. Unfortunately, the data fail to clarify the role of thrombolysis among patients presenting with acute lower extremity ischemia. However, they do suggest that thrombolysis may confer an advantage in properly selected patients. The current results strongly support the greater saphenous vein as the conduit of choice but provide little guidance for the subset of patients in whom it is inadequate. Finally, it is interesting to reflect on the current results in light of the expanding list of publications documenting the feasibility and safety of the alternative endovascular approach. Interestingly, poor arterial runoff, a predictor of graft failure in this study, was an exclusion criterion in the randomized, controlled trial comparing open and endovascular popliteal artery aneurysm repair cited previously (see reference 23). It is conceivable that the endovascular approach may be equivalent to open repair for asymptomatic patients with good arterial runoff, although this needs to be confirmed by long-term follow-up. Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: Is exclusion with saphenous vein bypass still the gold standard?Journal of Vascular SurgeryVol. 45Issue 4PreviewPopliteal artery aneurysms (PAAs) are rare, but thromboembolic complications may result in limb loss. To define complications and outcomes after open surgical repairs, we reviewed our experience. Full-Text PDF Open Archive