Outcomes of Popliteal Endarterectomy and Infrapopliteal Angioplasty for Short Atherosclerotic Popliteal Artery Occlusion: Single-Center Case Series

Abstract

Localized popliteal artery occlusion (LPAO) is a rare entity with a challenging therapy. In selected patients, open popliteal endarterectomy (OPE) with infrapopliteal balloon angioplasty (IPA) can be limb-saving. The aim of this retrospective study from Iraq-Kurdistan is to assess the procedure outcomes. Over 5years, ending at 2020, 28 patients with atherosclerotic LPAO unsuitable for femoropopliteal bypass or endovascular intervention received OPE+IPA through a medial approach under spinal anesthesia. Perioperative data were obtained from patients' records and entered into an Access database. Results were retrieved and statistically analyzed. There were 18 (64.3%) males. The mean age was 66.4±6.53years (range 52-79 years). Seventy five percent of patients had obesity, diabetes mellitus, and smoking. Twenty six (92.9%) of patients were in Rutherford category 5 and 6 with an ankle-brachial index < 0.40. Popliteal and pedal pulses were absent in 23 of 24 (95.8%) patients. Doppler ultrasound showed a good distal runoff in 1 (3.6%) patient. Computed tomography angiography revealed 20 (71.4%) femoropopliteal and 16 (57.1%) infrapopliteal lesions of types A and B as per Trans-Atlantic Inter-Society Consensus II document. Mean endarterectomy length was 5.1cm (range 3-7), patched with a vein in (17, 60.7%) and primarily closed in (11, 39.3%) patients. Early complications were none in (18, 64.3%) patients whereas 1 leg was amputated on day 30. On average, follow-up lasted 3.4years. Twenty seven (96.4%) vessels remained patent and 2 (7.1%) patients died. Our study confirms safety and efficacy of OPE+IPA for selected patients with critical limb ischemia due to LPAO.