Endovascular Popliteal Artery Aneurysm Repair Research Articles

Popliteal artery aneurysm repair-A single center experience.

Popliteal artery aneurysms (PAAs) are relatively rare but are one of the most common peripheral arterial aneurysms. Open popliteal artery aneurysm repair (OPAR) has been the standard, but technological advancements have made endovascular popliteal artery aneurysm repair (EPAR) a promising alternative. The aim of this study is to compare EPAR and OPAR efficacy and outcomes over a 10-year period. This study retrospectively reviewed 72 patient charts who were diagnosed with PAA or popliteal artery pseudoaneurysm and underwent EPAR or OPAR from 1 January 2010 to 31 December 2019. Endovascular popliteal artery aneurysm repair was used in 37 cases and OPAR in 35 cases. Graft patency <30 days postoperative was 100% in both EPAR and OPAR groups. Graft patency >90 days postoperative was 72.73% in the EPAR group and 82.35% in the OPAR group (p = 0.477). Graft patency >2 years postoperative was 81.25% in the EPAR group and 86.67% in the OPAR group (p = 0.682). Freedom from reoperation 30-day postoperative was 78.38% in the EPAR group and 80% in the OPAR group (p = 0.865). Freedom from amputation 30-day postoperative was 91.43% in the EPAR group and 94.29% in the OPAR group (p = 0.263). The 30-day survival rate was 94.59% in the EPAR group and 100% in the OPAR group. Endovascular repair represents a promising alternative for PAA repair. Our results demonstrate that EPAR has similar outcomes for asymptomatic, acutely symptomatic, and chronic symptomatic patients. Technological advancements of stent properties and refinement of surgical techniques may further improve endovascular techniques.

Endovascular Popliteal Artery Aneurysm Repair Using an "Off-Label" Abdominal Endograft Limb-Module with Nitinol-Ring Structure: A Single Centre Experience.

To evaluate endovascular popliteal artery aneurysm repair using a an "off-label" abdominal endograft limb-module with nitinol-ring structure. Retrospective observational study of 14 popliteal artery aneurysms in 12 male patients (mean age 76years and median ASA grade 3) treated electively using the Anaconda™ endograft limb (Terumo Aortic) at a single teaching hospital. Eight limbs were treated percutaneously and 6 limbs required surgical arterial exposure. The mean popliteal artery aneurysm diameter treated was 3.6cm (range 2.1-5.3cm). Stent-graft diameters and lengths used were 10-15 and 60-140mm, respectively. The median covered stented length was 218mm (range 160-270mm) and median duration of follow-up was 3.7years. Outcomes assessed included technically successful aneurysm exclusion, primary patency, re-intervention and survival. All patients had successful stent-graft deployment and aneurysm exclusion, with no early complications or mortality at 30days. Primary stent-graft patency at 1, 3 and 4years was 93%, 75%, and 64%. By 8years, patency had declined with 29% (2/14) stent-grafts patent. 7/14 limbs occluded; 3 underwent re-intervention (2 surgical, 1 endovascular). There were no deaths related to the procedure. Freedom from re-intervention and survival at 1/5years was 93%/84% and 93%/67%, respectively. The Anaconda™ endograft limb for endovascular popliteal artery aneurysm repair offers good mid-term patency and acceptable long-term patency up to 4years when compared with other grafts and open surgery. It may be considered in older comorbid patients unfit for surgery and can be performed percutaneously under local anaesthesia when anatomically feasible.

IP229. Treatment Trends and Outcomes of Endovascular Popliteal Artery Aneurysm Repair in U.S. Women: A Vascular Quality Initiative National Study

IP229. Treatment Trends and Outcomes of Endovascular Popliteal Artery Aneurysm Repair in U.S. Women: A Vascular Quality Initiative National Study

Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator.

Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.

Long-term outcome of endovascular popliteal artery aneurysm repair

ObjectiveThe position of endovascular treatment in the algorithm of popliteal artery aneurysm (PAA) repair is still a matter of debate. Although several studies have described results similar to those of open surgery, follow-up of the endovascular group has been relatively short so far. The aim of this study was to describe the long-term outcome of endovascular repair of PAA with endografts. MethodsAll patients with a PAA treated with an expanded polytetrafluoroethylene stent graft between June 1998 and November 2014 in a tertiary referral center were prospectively gathered in a database and retrospectively analyzed. The primary end point of this study was primary patency. Secondary end points included primary assisted and secondary patency, survival of the patient, stent fractures, secondary interventions, and limb loss. ResultsA total of 75 PAAs were treated in 64 patients with a mean age of 68.1 ± 9.4 years. Unilateral PAA was present in 39 patients (61%) and bilateral PAAs in 25 patients (39%), of which 11 (17%) were treated bilaterally. Median follow-up was 68 months (range, 2-187 months). Primary patency at 1 year, 5 years, and 10 years was 84%, 60%, and 51%, respectively; primary assisted patency, 84%, 65%, and 57%; and secondary patency, 89%, 71%, and 60%. Stent fractures occurred in 28% of the cases (n = 21) in a median follow-up time of 47 months (range, 14-187 months). One-third of the fractures were associated with an occlusion that mainly presented with claudication, and only one was associated with acute ischemia. Reinterventions were performed in 12 cases (16%) during a median follow-up of 14 months (range, 1-47 months). The reintervention-free survival after 1 year, 5 years, and 10 years was 93%, 79%, and 79%, respectively. No major amputations were performed. The overall survival rate after 5 years and 10 years was 78% and 46%, respectively. ConclusionsEndovascular repair has established a definitive role in the treatment protocol for PAAs. It is associated with acceptable long-term patency rates. Stent fractures occurred in almost one-third of cases but never led to limb loss. Future developments should focus on the design of more dedicated and durable stents for this specific indication.

VP46 Cost Analysis Of Popliteal Aneurysm Management

INTRODUCTION:Popliteal artery aneurysm (PAA) is the most common peripheral arterial aneurysm and the second most common aneurysm after abdominal aortic aneurysm (AAA). It presents a risk of occlusion, which may lead to acute ischemia and leg amputation. To prevent these risks, asymptomatic PAA &gt;2cm and symptomatic PAA must be treated. Although open PPA repair (OPAR) is still the gold standard, endovascular PAA repair (EPAR) is increasingly used to manage PAA. The objective of this study is to compare the cost of these two medical procedures from the hospital perspective.METHODS:Data were retrieved from the administrative database of Lausanne University Hospital (CHUV – Switzerland). Based on diagnostic codes and medical procedure codes, we selected all patients who underwent OPAR or EPAR between 2011 and 2015. Patient's age, length of stay and cost were compared between both groups using Student t-test.RESULTS:We included seventy-three patient stays (OPAR forty and EPAR thirty-three). Gender balance was identical between groups (97 percent of male), but age was statistically significantly different (OPAR 67.5, EPAR 73, p = .04). EPAR induced shorter mean length of stay (5.1 days versus 11.7 days, p = .0000) and lower mean global cost (CHF 16,555 versus CHF23,514, p = .0085). Cost of procedure amounted to CHF 9,536 for OPAR versus CHF 3,848 for EPAR, medical supply and implants amounted to CHF 1,284 for OPAR versus CHF 7,041 for EPAR and other costs of hospital stay amounted to CHF 12,694 for OPAR versus CHF 5,666 for EPAR. (CHF 1.00 = USD1.00 = EURO 0.93)CONCLUSIONS:With higher patency rate, OPAR is still associated with better medical outcomes than EPAR. But EPAR is significantly less costly than OPAR. Implant cost of EPAR is more than offset by longer length of stay and operating time of OPAR.

Contemporary outcomes of open and endovascular popliteal artery aneurysm repair

The purpose of this study was to evaluate contemporary practice and outcomes of open repair (OR) or endovascular repair (ER) for popliteal artery aneurysms (PAAs). Consecutive patients with PAA treated at one institution from January 2006 to March 2014 were reviewed under an Institutional Review Board-approved protocol. Demographics, indications, anatomic characteristics, and outcomes were collected. Standard statistical methods were used. A total of 186 PAAs were repaired in 156 patients (110 ORs, 76 ERs) with a mean age of 71 ± 11 years, and most were male (96%). Mean follow-up was 34.9 ± 28.6 months for OR and 28.3 ± 25.8 months for ER (P = .12). Comorbidities were similar between groups. OR was used in more patients with PAA thrombosis (41.8% vs 5.3%; P < .001), acute ischemia (24.5% vs 9.2%; P = .010), and ischemic rest pain (34.5% vs 6.6%; P < .001). Mean tibial (Society for Vascular Surgery) runoff score was 5.0 for OR vs 3.3 for ER (P = .006). OR was associated with increased 30-day complications (22% vs 2.6%; P < .001) and mean postoperative stay (5.8 vs 1.6 days; P < .001). There was no difference in 30-day mortality (OR, 1.8%; ER, 0%; P = .56) or major amputation rate (OR, 3.7%; ER, 1.3%; P = .65). Primary, primary assisted, and secondary patency rates were similar at 3 years (OR, 79.5%, 83.7%, and 85%; ER, 73.2%, 76.3%, and 83%; P = NS). Among 130 patients presenting electively without acute ischemia or thrombosed PAA (63 ORs and 67 ERs), OR had better 3-year primary patency (88.3% vs 69.8%; P = .030) and primary assisted patency (90.2% vs 73.5%; P = .051) but similar secondary patency (90.2% vs 82%; P = .260). ER thrombosis was noted in 8 of 24 patients treated in 2006-2008 (33%; mean time to failure, 49 months) but in only 4 of 51 patients treated in 2009-2013 (7.8%; mean time to failure, 30 months), suggesting a steep learning curve. ER is a safe and durable option for PAA, with lower complication rates and a shorter length of stay. OR has superior primary patency in patients treated electively but no difference in midterm secondary patency and amputations.

Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair

Open (OPAR) and endovascular (EPAR) repair are both used to treat popliteal artery aneurysm (PAA). We assessed outcomes of both modalities in the treatment of asymptomatic PAAs. Vascular Quality Initiative (VQI) databases (2010 to 2013) were queried for patients undergoing asymptomatic PAA repair using OPAR and EPAR. The groups were compared with respect to demographics, medical history, and procedural characteristics. Outcomes of interest were length of stay (LOS), major adverse limb events (MALE), MALE or perioperative death (MALE-POD), and loss of primary patency compared using Kaplan-Meier estimates. Proportional hazard Cox regression was used to compare the outcomes across the treatment groups. Multivariable regression with backward elimination procedure (α = .5) was used to construct parsimonious models to predict MALE and MALE-POD. Gamma regression was used to compare LOS. From 2010 to 2013, 390 patients with asymptomatic PAAs were identified (221 OPAR, 169 EPAR) and included in this study. Preoperative comorbidities were similar between the two groups, except for a higher rate of congestive heart failure (19.5% vs 11.8%, P = .042) and chronic obstructive pulmonary disease (19.5% vs 11.8%, P = .042) in the EPAR group. No in-hospital mortality was observed. LOS was significantly longer in the OPAR group (3.8 ± 2.5 vs 1.4 ± 1.9 days; P < .001). OPAR patients had a significantly higher MALE-free survival (95% vs 80%; P < .001) as was MALE-POD-free survival (93% vs 80%; P < .001) rates at 1 year after the procedure. OPAR was associated with lower hazard of MALE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.15-0.86; P < .05), MALE-POD (HR, 0.28; 95% CI, 0.13-0.63; P < .05), and primary patency loss (HR, 0.25; 95% CI, 0.10-0.58; P < .05). This retrospective analysis suggests that OPAR is associated with better outcomes than EPAR. Ultimately, the ongoing, adequately powered Open versus Endovascular Popliteal Artery Aneurysm Repair (OVERPAR) trial will definitively compare these procedures.

Using Vascular Quality Initiative as a Platform for Organizing Multicenter, Prospective, Randomized Clinical Trials: OVERPAR Trial

We describe the organization of a prospective, randomized, multicenter trial comparing the effectiveness of open popliteal artery aneurysm repair (OPAR) and endovascular popliteal artery aneurysm repair (EPAR) of asymptomatic popliteal artery aneurysms (PAAs) as an example for how to use the Vascular Quality Initiative (VQI) framework. Given that many centers participate in the VQI, this model can be used to perform multicenters' prospective trials on very modest budget. VQI prospectively collects data on many vascular procedures. These data include many important perioperative, intraoperative, and postoperative details regarding both patients and their procedures. We describe a study where minimal changes to the collected data by participating centers can provide level-1 evidence regarding a significant clinical question. Data will be collected using modified VQI forms within the existing VQI data reporting structure. We plan to enroll 148 patients with asymptomatic PAAs into the open and endovascular surgery cohorts. Patients from participating VQI centers will be randomized 1:1 to either OPAR or EPAR and will be followed for an average of 2.5 years. Our primary hypothesis is that major adverse limb event-free survival is lower in the EPAR cohort and that EPAR is associated with more secondary interventions, improved quality of life, and decreased length of stay. The budget for this trial is fixed at $10,000/year for the course of the study, and the trial is judged to be feasible because of the functionality of the VQI platform. Using the existing VQI infrastructure, Open versus Endovascular Repair of Popliteal Artery Aneurysm will provide level 1 data for PAA treatment on a modest budget. The proposed trial has an adequately powered comparative design that will use objective performance goals to describe limb-related morbidity and procedural reintervention rates.

Long-term Outcomes and Sac Volume Shrinkage after Endovascular Popliteal Artery Aneurysm Repair

The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair (EVPAR). This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan-Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis. Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases (n = 43) the procedure was elective, while in 7% of cases it was for rupture (n = 2) or acute thrombosis (n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p < .001). Segment coverage >20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p = .032). EVPAR provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure.

Long Term Outcomes and Sac Volume Shrinkage After Endovascular Popliteal Artery Aneurysm Repair

To evaluate long term outcomes and sac volume (SV) shrinkage after endovascular popliteal artery aneurysm repair (EVPAR). A retrospective review of EVPAR cases performed between January 1999 and December 2012. SV shrinkage, long term patency, limb salvage (LS), and survival (S) were evaluated with K-M estimates. Anatomical characteristics and clinical presentation were evaluated for their association with patency using multiple logistic regression. 46 EVPAR procedures in 42 patients. Mean age was 68 yr, 86% were male; mean SV 42 ± 12 cm3. Elective repair in 91% of cases, while 9% treated for rupture or thrombosis; 56% were asymptomatic, 35% had claudication and 9% rest pain. Technical success was 98%. At mean follow-up of 84 months (range, 6 to 138 months) primary, assisted primary, and secondary patency was 63%, 68%, and 68%; LS was 96% and S 81%. Of the 13 limbs with stent graft failure, seven required conversion, two underwent amputation, while four remained with mild claudication. Of those with graft occlusion, 61% (8 out of 13) of cases occurred within the first year of follow-up. The overall mean difference in aneurysm SV shrinkage at 7 years was significant (42 ± 12 cm3 vs 21 ± 8 cm3; P = .02). The association of covering a length >20 cm and distal landing zone between 1 and 1.5 cm from the take off of the anterior tibial artery (ATA) was a negative predictor for improved patency (OR, 3.05; 95% CI, 1.9 to 2.3; P = .005). EVPAR provides successful aneurysm exclusion with acceptable long term patency, excellent LS and S. However, close surveillance is required, particularly within the first postoperative year. Patients requiring coverage >20 cm and a distal landing zone between 1 and 1.5 cm from the ATA may be at increased risk for failure.

Results of elective and emergency endovascular repairs of popliteal artery aneurysms

Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P = .14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P = .56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P = .15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.

PP32. Midterm Results with Endovascular Popliteal Artery Aneurysm Repair with ePTFE Covered Stent Grafts

PP32. Midterm Results with Endovascular Popliteal Artery Aneurysm Repair with ePTFE Covered Stent Grafts

Mid-term outcomes of endovascular popliteal artery aneurysm repair

Mid-term outcomes of endovascular popliteal artery aneurysm repair

Invited commentary

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

Mid-term outcomes of endovascular popliteal artery aneurysm repair

This study documents mid-term outcomes of a series of endovascular popliteal aneurysm repairs compared with concurrent results of open surgical repair. A retrospective chart review was done of all popliteal artery aneurysm repairs since January 1, 2000. Patency was defined as continued presence of palpable pulses or maintenance of postoperative ankle-brachial index +/- 0.15. Statistical methods included chi(2), t test, Fisher's exact test, and Kaplan-Meier plots with log-rank comparison. A total of 56 popliteal artery aneurysm repairs were performed. All endovascular popliteal aneurysm repairs (EVPAR, n = 15) were performed using Viabahn endoprostheses. Patients with open repair (OR, n = 41) underwent surgical bypass and aneurysm exclusion with great saphenous vein (n = 26), short saphenous vein (n = 3), or polytetrafluoroethylene (n = 12), through either a medial (n = 28) or posterior (n = 13) approach. All urgent cases received open repair. Technical success was 100% in both groups. Mean follow-up was 16.5 +/- 3 months (range, 0.5 to 56 months). Aneurysm size, location, and outflow were similar between groups. Primary patency, secondary patency, and survival did not differ between groups. Endoleaks were observed in three (20%) of 15 endovascular cases, and type I and III endoleaks were treated with additional endografts. To our knowledge, this represents the largest United States series of EVPAR to date. Early mid-term results of elective endovascular repair of popliteal artery aneurysms are encouraging. Further studies are warranted to define optimal indications for EVPAR and to generate long-term outcomes for this technique.

Stability of meta-analysis (M-As) of randomized control trials (RCTs): A retrospective study of 10 published M-As by sequential M-As and the implications for prospective M-As

Endovascular popliteal artery aneurysm repair (EPAR) is increasingly used over open surgical repair (OPAR). The purpose of this study was to analyze the available literature on their comparative outcomes.The PubMed and Embase databases were searched to identify studies comparing OPAR and EPAR. Studies with only one treatment and fewer than five patients were excluded. Demographics and outcomes were collected. Bias risk was assessed using a modified version of the Newcastle-Ottawa Scale. Results were computed from random-effects meta-analyses using the DerSimonian-Laird algorithm.A total of 14 studies were identified encompassing 4880 popliteal artery aneurysm repairs (OPAR, 3915; EPAR, 1210) during the last decade. OPAR patients were younger (standard mean difference, −0.798 [−0.798 to −1.108]; P < .001) and more likely to have worse tibial runoff (odds ratio [OR], 1.949 (1.15-3.31); P = .013) than EPAR patients. OPAR had higher odds of wound complications (OR, 5.182 [2.191-12.256]; P < .001) and lower odds of thrombotic complications (OR, 0.362 [0.155-0.848]; P < .001). OPAR had longer length of stay (standardized mean difference, 2.158 [1.225-3.090]; P < .001) and fewer reinterventions (OR, 0.275 [0.166-0.454]; P < .001). Primary patency was better for OPAR at 1 year and 3 years (relative risk, 0.607 [P = .01] and 0.580 [P = .006], respectively). There was no difference in secondary patency at 1 year and 3 years (0.770 [P = .458] and 0.642 [P = .073], respectively).EPAR has a lower wound complication rate and shorter length of hospital stay compared with OPAR. This comes at the cost of inferior primary patency but not secondary patency out to 3 years. Studies reporting long-term outcomes are lacking and necessary.