Endovascular Treatment Of Popliteal Aneurysms Research Articles

Endovascular treatment of popliteal aneurysms with Viabahn®: retrospective multicentric study

Introduced in France in 2011 as an alternative to surgery (OR), the endovascular treatment of popliteal aneurysms (PAs) with Viabahn (ER) remains debated. A retrospective multicentric study was undertaken to validate or not this technique.

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.

Evolving treatment of popliteal artery aneurysms

Over the past decade, the treatment of popliteal aneurysms has evolved at our institution from sole operative intervention during the initial part of the study period, to combined surgical and endovascular treatment, and finally to endovascular-centered management in more recent years. This is a retrospective review of all patients with popliteal aneurysms treated at our institution from 2001 to 2011. Data collection included the indication for intervention, treatment details, interventional patency, limb salvage, perioperative outcome, and midterm survival. Eighty-eight aneurysms (72 patients) were treated during this period. Indications for intervention included symptomatic presentations in 53% (n = 47) and asymptomatic in 47% (n = 41). Treatment included endovascular exclusion in 24, surgical repair in 63 (14 posterior approach and 49 medial approach with bypass and exclusion), and primary amputation in one patient. Nine aneurysms (10.2%) received catheter-directed thrombolysis. Demographics were similar between the two treatment cohorts, except for age with endovascular stenting patients being significantly older (76.0 vs 66.0 years; P = .002). The mean length of stay was 3.9 days vs 9.5 days (P < .001), favoring endovascular treatment. There were no perioperative (30-day) deaths in the endovascular group and one in the surgical cohort. The mean patency follow-up was 21.2 vs 28.3 months. Primary patency did not differ between endovascular and surgically treated patients at 1 year (92.9% vs 83.3%; P = .26) and 3 years (63.7% vs 77.8%; P = .93). No limbs were lost in the endovascular group during the follow-up period of 22.4 months, and one late limb loss occurred in the surgical cohort (mean follow-up, 29.2 months). Endovascular patients had a midterm survival rate of 65% (mean follow-up, 33.9 months), whereas surgical patients experienced a survival rate of 80.8% (mean follow-up, 42.9 months; P = .22). Endovascular treatment of popliteal aneurysms provides similar short-term patency to that of the traditional gold standard approach with surgical bypass, with shorter hospitalizations in both symptomatic and asymptomatic patients. Further long-term follow-up is required to compare these two treatment modalities for durability to determine the optimal popliteal aneurysm management.

Evolving Treatment of Popliteal Artery Aneurysm

During the past decade, the treatment of popliteal aneurysms has evolved at our institution from the sole operative intervention during the initial part of the study period, to combined surgical and endovascular treatment, and finally, to endovascular-centered management in more recent years. Outcomes among treatment modalities for popliteal aneurysms were assessed. This is a retrospective review of all patients with popliteal aneurysms treated at our institution from 2001 to 2011. Data collection included the indication for intervention, treatment details, interventional patency, limb salvage, perioperative outcome, and long-term survival. During this period, 88 aneurysms were treated in 72 patients. Indications for intervention included 47 (53%) with symptomatic presentations, and 41 (47%) were asymptomatic. Treatment included endovascular exclusion in 24, surgical repair in 63 (14 posterior approach and 49 medial approach with bypass and exclusion), and primary amputation in one patient. Nine aneurysms (10.2%) received catheter-directed thrombolysis (Fig). Demographics were similar between the two treatment cohorts, except for age, with endovascular stenting patients significantly older (76.0 vs 66.0 years, P = .002). The mean length of stay was 3.9 vs 9.5 days (P < .001), favoring endovascular treatment. There were no perioperative (30-day) deaths in the endovascular group and one death in the surgical cohort. The mean patency follow-up was 18.5 vs 28.3 months. Primary patency did not differ between endovascular and surgically treated patients at 1 year (92.3% vs 83.3%, P = .26) and 3 years (61.5% vs 77.8%, P = .89). No limbs were lost in the endovascular group during the follow-up period of 22.4 months. One late limb loss occurred in the surgical cohort (mean follow-up, 29.2 months). The long-term survival rate was 65% in the endovascular patients (mean follow up, 33.9 months) and 80.8% in the surgical patients (mean follow up, 42.9 months, P = .22). Endovascular treatment of popliteal aneurysms provides similar short-term patency to that of the traditional gold standard approach with surgical bypass, with shorter hospitalizations in symptomatic and asymptomatic patients. Further long-term follow-up is required to compare these two treatment modalities for durability to determine the optimal popliteal aneurysm management.

Resultados del tratamiento endovascular de los aneurismas de arteria poplítea

ObjectiveTo evaluate the long term results of the endovascular treatment of popliteal aneurysms. Patients and methodsA retrospective analysis of 27 popliteal aneurysms in 24 patients operated on between January 2004 and December 2010. Endpoints: Complications, limb salvage and patency using the Kaplan-Meier method. ResultsThe mean age of the patients was 69±12 years. The mean diameter of aneurysms: 29.5±13mm. There were three run-off vessels patency in 52%. Six aneurysms were symptomatic. The technique with dissection of the proximal superficial femoral artery was used in 25 cases, and percutaneous in two. Fluency endografts were used in 21 cases, and Viabahn/Hemobahn in 6. The average number of stent-grafts per case was two. Initial tecnical success was obtained in 100%. There was no postoperative morbidity or mortality. The average in-hospital stay was 2.6±2 days. Clinical and duplex follow-up was possible in all patients. Nine occlusions (seven during the first year) were documented, with an average follow-up of 51±24 months. Other complications: two migrations with endoleak type I, two fractures, and one contained rupture. There were six conversions to bypass surgery, most of them due to failed thrombolysis, all remaining patent. Primary and secondary patency at 4 years was 66 and 72%, and limb salvage was 100%. No patient was lost in the follow-up, and two died of neoplasia. ConclusionsEndovascular treatment of popliteal aneurysms is a feasible and safe therapeutic alternative to conventional bypass surgery, with low morbidity and mortality.

Endovascular Popliteal Aneurysm Repair: Are the Results Comparable to Open Surgery?

Introduction The aim of this study was to review our experience of popliteal aneurysms using endovascular techniques. Methods Thirty popliteal aneurysms in 25 patients were treated over an 11-year period. Median aneurysm diameter was 26 (16–48) mm. Five were symptomatic and 25 asymptomatic. Patients were treated with the Haemobahn/Viabahn stent-graft (26), Passager (two), Aneurx (one), and PTFE homemade device (one). Data were assessed using life table analysis, and expressed as cumulative patency rates and standard error (SE). Results Median follow-up was 24 (range 1–95) months. Primary patency was 92.9% (SE 4.5%), 84.7% (SE 6.8%), 80% (SE 8.2%), 74.5% (SE 9.4%) and 74.5% (11.3%) at 1, 6, 12, 24 and 36 months, respectively. Cumulative secondary patency was 96.5% (SE 3.3%), 88.7% (SE 6.0%), 88.7% (SE 8.6%), 83.2% (SE 8.0%) and 83.2% (SE 9.8%) at 1, 6, 12, 24 and 36 months, respectively. Conclusion Endovascular treatment of popliteal aneurysms in this series achieved patency rates similar to open surgery. Aneurysm repair was performed without peroperative deaths and the risks associated with open surgery.

Endovascular Treatment of Popliteal Artery Aneurysms

Objective. To present the results of the endovascular treatment of popliteal artery aneurysms. Methods. From April 1999 to January 2002, 11 patients, aged 40–94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to a aneurysm rupture. Aneurysm diameter was 28–105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case. Results. During a mean follow-up of 14 (3–31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively. Conclusion. Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results.

Three-dimensional volume rendered CT for preparation and evaluation of endovascular treatment of popliteal aneurysms

The purpose of this study was to evaluate the use of three-dimensional rendering of Computed Tomography Angiography (CTA) data for the evaluation of the poplitea before and after the placement of an endoprosthesis using scans both with the knee in flexion and extension. In 12 patients, 17 poplitea aneurysms were found, of which 12 were selected for endovascular treatment. Before and after the treatment of the patient, a CTA was performed both in extension and flexion and the acquired data were volume rendered using special purpose volume rendering software. The results were presented to the vascular surgeon as movies showing a full rotation of a three-dimensional image of the poplitea area. With the use of three-dimensional (3D) visualization, especially with the knee in flexion, locations of kinking and coiling of the popliteal artery were clearly observed. Based on these observations the endograft was exactly positioned during the endovascular procedure. The goal of the treatment was to bypass both the aneurysm and bending points in the artery. Correct placement of the endograft was evaluated by control CTA in flexion and extension. Although the endograft was positioned at the desired location, residual kinking sites were observed. During follow-up in three cases, the endograft failed. Urokinasis treatment was successful in all three cases. In two cases, a severe stenosis had developed at the specific residual kinking sites at the end of Hunter's channel. In both cases, PTA and additional stent placement was performed. A second control CTA showed no residual kinking or stenosis. In one case, a stenosis developed in the popliteal artery just distal of the endograft, which was treated with a PTA. This study showed that high resolution CTA scanning in flexion and extension of the popliteal artery both before and after intervention is feasible. High quality three-dimensional visualization of the popliteal artery has a high predictive value in the determination of future kinking sites of the artery after endograft placement. Therefore, it is helpful in the selection, work-up and evaluation of patients for endovascular treatment of popliteal aneurysms.