Popliteal Artery Aneurysm Repair With Minimally Invasive Endoscopic Vein Harvest Yields Outstanding Wound Healing Outcomes With Fast-Tracked Hospitalization

Abstract

There is growing literature showing that minimally invasive vein harvest (MIVH) is safe, with good patency rates and decreased wound complications, in treating infrainguinal occlusive disease. Our institution has performed MIVH since 2003 with a dedicated team of providers specializing in endoscopic vein harvest. The purpose of this study was to specifically evaluate major outcomes of MIVH as an adjunct to the standard, open operative repair of popliteal artery aneurysms. We performed a 10-year, retrospective, single-institutional chart review from January 2005 to December 2014, identifying all patients undergoing popliteal artery aneurysm repair with MIVH. Primary outcomes were procedural technical success, operative time, wound complication, major morbidity, and freedom from amputation. A total of 27 patients received MIVH popliteal artery aneurysm repair at an average age of 66 ± 10 years; 44% of the patients presented without symptoms or with claudication and 56% with rest pain or tissue loss. The average size of the popliteal aneurysm was 3.6 ± 2.3 cm at the time of repair. Contralateral popliteal artery aneurysms existed in 30% of the patients, 40% had concurrent aortic or iliac artery aneurysms, and 30% had no other known aneurysms. Of 27 limbs, 25 (93%) were treated through a medial approach with aneurysm ligation, and 2 patients (7%) were treated through a posterior approach. The average vein size was 4.5 ± 0.9 mm, with 89% harvested by the ipsilateral great saphenous vein. Average operative time was 237 ± 53 minutes, with a median hospitalization of 3 days and an average of 1.4 days of intravenous narcotics use. At time of first follow-up, 89% of patients were back to baseline mobility. Only two patients (7%) had Szilagyi class 2 surgical site infections remedied with débridement and antibiotics. At last follow-up, 96% of patients had freedom from amputation in this long-term series. MIVH for popliteal aneurysmal disease provides a safe and relatively expeditious means of popliteal artery aneurysm repair with short hospitalization, low wound complication rates, and excellent freedom from amputation.