Long-term Outcome of Endovascular Repair of Popliteal Artery Aneurysm Presents a Credible Alternative to Open Surgery

Abstract

Endovascular repair of popliteal artery aneurysms (PAA) has become increasingly popular; however, long-term patency and limb salvage rates are not fully established. A retrospective review of all endovascular PAA repairs at our institution (from 2005 to 2012) identified 34 PAAs in 26 patients, of which 32% presented with acute symptoms. PAA were repaired with either Hemobahn(®) or Viabahn(®) endografts, using an entirely percutaneous approach. All patients were given Clopidogrel and/or aspirin postoperatively. Mean follow-up duration was 40 (range 4-86) months. Kaplan-Meier analysis was used to determine primary patency, secondary patency, and limb salvage rates. Complications and reintervention rates also were examined. At 1, 3, and 5years follow-up, the primary graft patency was 88, 82, and 82%, respectively, and secondary patency was 90, 86, and 86%. Amputation-free survival at 1, 3, and 5years was 97, 94, and 94%, respectively. Technical success was achieved in 100%. There were five graft occlusions: one was asymptomatic, one was treated with thrombolysis successfully, and one was thrombolysed but reoccluded resulting in nondisabling claudication. Two were not suitable for thrombolysis and required amputation. The overall reintervention rate was 12%. The primary and secondary patency rates of endovascular repair of PAA are equivalent to the reported outcome of open repair. Reintervention and limb salvage rate appears better than open repair. With improved long-term outcomes, endovascular repair can be considered a credible treatment strategy for routine uncomplicated PAA.