Repair Of Popliteal Artery Aneurysms Research Articles

External Stenting and Disease Progression in Vein Grafts After Open Surgical Repair of Popliteal Artery Aneurysms

Open surgical repair has remained the reference standard treatment of popliteal artery aneurysms (PAAs). The objective of the present study was to evaluate the feasibility and safety of external stenting and its potential preventive effect on vein graft disease after open PAA repair.

Common surgical practice in treatment of patients with popliteal artery aneurysm among Serbian vascular centers

Background/Aim. Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm and second most common aneurysm following abdominal aortic aneurysm (AAA). Still, its incidence is rare and treatment non-standardized. Collection of data in multicenter registry could improve diagnosis and treatment. SerbVasc is newly established data collection collaboration among Serbian Vascular centers. The aim of this study was to assess common surgical practice in diagnosis and treatment of patients with PAA in Serbian hospitals. Methods. Serbian vascular centers that accepted invitation collected retrospectively data about operated patients for PAA in the period 2012-2018. Data regarding symptoms, preoperative diagnostics, vascular and endovascular techniques and postoperative results were collected. This data set was submitted to the VASCUNET international project of PAA for data analysis between the countries. The same data set was used for detailed analysis of contemporary treatment of PAA in six Serbian hospitals: Serbian Clinical Centre (SCC), Dedinje Cardiovascular Institute (CVID), Military Medical Academy (MMA), Clinical Center Novi Sad (CCNS), Clinical Centre Nis (CCN) and County Hospital Uzice (CHU). Results. In the period 2012-2018 in six Serbian hospitals data for 342 procedures due to PAA were collected in 329 (96.2%) men and only 13 (3.8%) women. Incidence of PAA repair was 6.8 operations/million inhabitants /year. Mean age of patients was 64.34 years (ranging from 29 to 87). Total of 223 (65.8%) elective procedures were performed. Amputation and hospital survival were considered as the main outcomes. Thrombosis was recorded in 110 (32.4%) of patients, as a cause for surgery and rupture in 5 patients. Mean diameter of aneurysm was 35.28 mm being larger for ruptured aneurysms (43.8 mm) in average. Both synthetic and vein grafts were used in elective and urgent procedures equally. Endovascular procedures were performed in 6 (1.8 %) cases. Conclusion. This study confirms importance of registry-based collection of data and their analysis. It showed that national incidence of PAA in Serbia is low and that well organized, even per institution based, screening algorithm should improve recognition of such patients and increase number of electively treated PAA. Education of vascular surgeons to use posterior approach could improve vascular healthcare.

Early and mid-term outcomes of open popliteal artery aneurysm repair with prosthetic grafts

ObjectiveThe aim of the present study was to assess the early and mid-term outcomes of open surgical repair (OSR) for popliteal artery aneurysms (PAAs) with prosthetic grafts. MethodsThe pre-, intra-, and postoperative data for all the patients who had undergone OSR for PAAs with prosthetic grafts at our Institution between January 2009 and July 2019 were included in a prospectively maintained database, which was retrospectively analyzed. Primary patency was defined as uninterrupted flow (<50% stenosis) in the graft with no additional procedures performed. Secondary patency was defined as the restoration of graft patency. ResultsA total of 82 patients had undergone OSR for 104 PAAs (median age, 71 years; interquartile range [IQR], 67-78 years; 82 men) with prosthetic grafts. Of the 104 PAAs, 72 (68%) had been asymptomatic. The median diameter was 30 mm (IQR, 24-37 mm). A medial approach was used for 35 PAAs (34%) and a posterior approach for 69 (65%). The repairs consisted of aneurysmectomy or aneurysm ligation without removal with an interposition graft placed and end-to-end anastomoses. The median operative time was 120 minutes (IQR, 103-142 minutes). The estimated blood loss was 281 mL (IQR, 150-281 mL). Only one patient treated with a posterior approach sustained a permanent peroneal nerve lesion. A second patient also treated via the posterior approach had required surgical revision for bleeding on postoperative day 2. No temporary lesions were recorded. No early amputations were required, and no perioperative deaths occurred. The median length of stay was 3 days (IQR, 3-4 days). An expanded polytetrafluoroethylene graft was used in 92 cases (88%) and a Dacron graft in 12 cases (12%). An 8-mm graft was used in 64 cases (62%). The median follow-up was 34.6 months (IQR, 8.5-62.7 months). No related mortality occurred. Of the 104 PAAs, 19 had required reintervention, with primary and secondary patency of 78% and 88% at 3 years, respectively. The median interval to reintervention was 28.3 months. ConclusionsOSR of PAAs with prosthetic grafts is safe and feasible, with good mid-term results and satisfactory primary and secondary patency at 3 years.

A comparative analysis of anatomical variations of popliteal artery and its branches in concomitant aneurysmal disease.

Open or endovascular treatment of popliteal artery aneurysms (PAAs) is still debated. Data about the popliteal artery anatomy and its branches are essential to plan a surgical approach. The aim of this study was to report the anatomical variations of the popliteal artery and its branches in a population with aneurysmal disease and compare them with a standard population with non-aneurysmal disease. A retrospective review of consecutive patients who underwent surgical PAA repair in our center between January 2011 and December 2020 was performed. One-hundred-forty-six limbs in 128 patients underwent PAA treatment (Group 1). Computed tomography angiography images using a 128-section configuration were reviewed for anatomical variations of the popliteal artery and its branches. A control population of 178 limbs in 89 patients with non-aneurysmal disease was used to compare the outcomes (Group 2). All limbs were classified according to Kim's classification. The two groups were analyzed and compared by means of nonparametric Pearson chi-square test. Both groups were homogeneous in terms of demographics, risk factors, and clinical presentation. In Group 1, the limbs with PAA were classified as type IA, 133 (91.1%); type IB, 2 (1.4%); type IC, 0; type IIA1, 1 (0.7%); type IIA2, 1 (0.7%); type IIB, 4 (2.7%); type IIC, 0; type IIIA, 3 (2.1%); type IIIB, 0; and type IIIC, 2 (1.4%). In Group 2 the limbs with non-aneurysmal disease were classified as type IA, 163 (91.6%); type IB, 5 (2.8%); type IC, 1 (0.6%); type IIA1, 1 (0.6%); type IIA2, 3 (1.7%); type IIB, 2 (1.1%); type IIC, 0; type IIIA, 3 (1.7%); type IIIB, 0; and type IIIC, 0. No difference in terms of anatomy of the popliteal artery and its branches was found between the two groups (P = NS). Knowledge of anatomical variations of the popliteal artery and its branches is mandatory in case of the surgical approach. Anatomy in PAA patients is not different. Studies with larger population size are needed to validate these outcomes.

1430 Mid-Term Outcomes After Endovascular Repair of Popliteal Artery Aneurysms Demonstrate Satisfactory Patency Rates and Safety of Stent-Grafts

Abstract Aim Popliteal artery aneurysms (PAAs) are increasingly treated via an endovascular approach. We present mid-term outcomes of popliteal endovascular aneurysm repair (PEVAR) from a single centre. Method A retrospective analysis of a prospective database of consecutive patients who underwent either elective or emergency PEVAR in a single regional vascular centre from January 2010 to August 2020. The patients underwent placement of a heparin-bonded stent-graft (Viabahn Endoprosthesis, WL Gore and Associates, Flagstaff, USA) for PAA &amp;gt;20mm or complications: thromboembolism, rupture or popliteal vein thrombosis. Patency and stent-graft related complications were assessed. Results A total of 64 PAAs (mean size 36.8±13.4mm) were treated in 56 patients (mean age 75±10.7 years, 54 (96%) male). Median follow-up was 29.5 months (IQR 36.75). 30-day mortality was 0%. Technical success rate of stent-graft insertion was 100%. 1-year and 5-year primary patency was 83% and 67% respectively; primary-assisted patency at these time points was 86% and 72%, and the corresponding secondary patency was 89% and 75%. 61 out of 64 treated limbs had &amp;gt;1 vessel runoff. The most frequently occurring complication was stent-graft occlusion which affected 11 (17%) limbs. Stent-graft fracture occurred in 1 patient, resulting in endoleak. Conclusions Viabahn Endoprosthesis can be used successfully in treatment of PAA with acceptable short- and mid-term patency rates. One in five patients in this cohort required a reintervention, with most complications occurring in the first year postoperatively. Stent-graft fracture occurred only in one patient demonstrating that PEVAR is a safe option for PAA management in the intermediate term.

Outcomes of popliteal artery aneurysms treated by ligation and in-situ saphenous vein bypass.

Modality of elective repair (open or endovascular) of popliteal artery aneurysms (PAAs) is still debated. About open repair no strict evidence exists about the best surgical technique. The aim of this study was to report a 20-year experience with ligation and in-situ saphenous vein bypass for the elective treatment of PAAs. A retrospective review of consecutive patients who underwent elective open surgical PAA repair in our center between January 2001 and April 2020 was performed. Ninety-two limbs in 84 patients underwent a PAA ligation and in-situ saphenous bypass. Early (30 day) outcomes were assessed. Estimated 5-year outcomes according to Kaplan-Meier curves in terms of primary patency, primary assisted patency, secondary patency, and limb salvage were evaluated. Associations of patient and procedure variables with patency and limb salvage outcomes were sought with multivariate analysis. Patients were predominantly male (80/84, 95.2%) with a mean age of 73.1 years (range 50-89). In all cases technical success was obtained. The mean hospital stay was 5.8 days (range 2-27). Thirty-day overall mortality (N.=1) and major amputation (N.=1) rates were both 1.2%. Mean duration of follow-up was 31.3 months (range: 1-168). At 5 years estimated rates of primary patency, primary assisted patency, secondary patency, and limb salvage were 76.3%, 81.5%, 89.9%, and 96.6%, respectively. On multivariate analysis the associations were: primary patency with PAA diameter >30 mm (P=0.007), and poor run-off status (P<0.001); primary assisted patency with poor run-off status (P<0.001); secondary patency with poor run-off status (P=0.04). Major amputation had no independent predictors of poor outcomes. Elective surgical treatment of PAAs with ligation and in-situ saphenous vein bypass is safe, effective and durable with good 5-year outcomes in terms of overall patency and limb salvage. Poor run-off status seemed to be an independent predictor of worse patency rates. This surgical technique should be cautiously applied in patients with PAAs with a diameter >30 mm.

Open Repair Is Superior to Endovascular Repair of Symptomatic Popliteal Artery Aneurysms

Endovascular and open surgical treatment modalities are currently used to manage popliteal artery aneurysms (PAA) with conflicting data on comparative durability of both repairs. We aimed to study the comparative effectiveness of endovascular PAA repair (EPAR) compared with open PAA repair (OPAR).

Long-Term Outcomes of Popliteal Artery Aneurysms Treated by Ligation and in Situ Saphenous Vein Bypass

The modality of elective repair (open or endovascular) of popliteal artery aneurysms (PAAs) is still debated. No strict evidence exists regarding the best surgical technique for open repair. The aim of our study was to report a 20-year experience with ligation and in situ saphenous vein bypass for the elective treatment of PAAs.

Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 – 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 – 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 – 4.55, p < .001) for ER, but 3.03 (1.26 – 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 – 4.50, p = .003), but 4.68 (1.89 – 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 – 5.97], p = .003; and poor outflow HR 14.39 [3.46 – 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 – 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 – 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 – 2012 and 2014 – 2018). In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.

Outcome of Endovascular Repair of Popliteal Artery Aneurysms Using the Supera Stent

A retrospective, single-center review was performed from January 2016 to December 2018. A total of 29 popliteal artery aneurysms (PAAs) had been treated with Supera stents (Abbott Vascular, Abbott Park, Ill). The mean diameter of the aneurysms was 27 mm (range, 20-40 mm). Technical success was 100%, without any loss of runoff vessels. A double Supera stent was deployed in 10 patients. Complete sac thrombosis occurred in one third of cases (n = 10) at 1 year of follow-up. The diameter of the aneurysm remained stable, and all stents remained patent after a mean follow-up of 2 years. For endovascular repair of PAAs, the use of a thick interwoven-wire stent such as the Supera stent did not result in any cases of stent fracture, occlusion, or aneurysm increase.

A systematic review and meta-analysis of treatment and natural history of popliteal artery aneurysms.

To summarize the best available evidence comparing open vs endovascular popliteal artery aneurysm (PAA) repair. We also summarized the natural history of PAAs to support of the Society for Vascular Surgery guidelines. We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with PAAs treated with an open vs an endovascular approach. We also included studies of natural history of untreated patients. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was performed when appropriate. We identified 32 original studies and 4 systematic reviews from 2191 candidate references. Meta-analysis showed that compared with the endovascular approach, open surgical repair was associated with higher primary patency at1year (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.41-3.12), lower occlusion rate at 30days (OR, 0.41; 95% CI, 0.24-0.68) and fewer reinterventions (OR, 0.28; 95% CI, 0.17-0.45), but a longer hospital stay (standardized mean difference, 2.16; 95% CI, 1.23-3.09) and more wound complications (OR, 5.18; 95% CI, 2.19-12.26). There was no statistically significant difference in primary patency at 3years (OR, 1.38; 95% CI, 0.97-1.97), secondary patency (OR, 1.59; 95% CI, 0.84-3.03), mortality at the longest follow-up (OR, 0.49; 95% CI, 0.21-1.17), mortality at 30days (OR, 0.28; 95% CI, 0.06-1.36), or amputation (incidence rate ratio, 0.85; 95% CI, 0.56-1.31). The certainty in these estimates was, in general, low. Studies of PAA natural history suggest that thromboembolic complications and amputation develop at a mean observation time of 18months and they are frequent. One study showed that at 5years, approximately one-half of the patients had complications. This systematic review provides event rates for outcomes important to patients with PAAs. Despite the low certainty of the evidence, these rates along with surgical expertise and anatomic feasibility can help patients and surgeons to engage in shared decision-making.

Poor runoff and distal coverage below the knee are associated with poor long-term outcomes following endovascular popliteal aneurysm repair

ObjectiveReports of good short-term outcomes for endovascular repair of popliteal artery aneurysms have led to an increased use of the technique. However, data are lacking on long-term limb-related outcomes and factors associated with the failure of endovascular repair. MethodsAll patients who underwent endovascular popliteal aneurysm repair (EPAR) at a single institution from January 2006 to December 2018 were included in the study. Demographics, indications, anatomic and operative details, and outcomes were reviewed. Long-term patency, major adverse limb event-free survival (MALE-FS) and graft loss/occlusion were analyzed with multivariable cox regression analysis and Kaplan-Meier curves. ResultsWe included 117 limbs from 101 patients with a mean follow-up of 55.6 months (range, 0.43-158 months). The average age was 73 ± 9.3 years. Thirty-two patients (29.1%) were symptomatic (claudication, rest pain, tissue loss, or rupture). The stent grafts crossed the knee joint in 91.4% of cases. In all, 36.8% of procedures used one stent graft, 41.0% used two stent grafts, and 22.2% of procedures used more than two stent grafts. The median arterial length covered was 100 mm, with an average length of stent overlap of 25 mm. Tapered configurations were used in 43.8% of cases. The majority of limbs (62.8%) had a three-vessel runoff, 20.2% had a two-vessel runoff, and 17% has a one-vessel runoff. The Kaplan-Meier estimates of graft occlusion at 1 and 3 years were 6.3% and 16.2%, respectively. The 1- and 3-year primary patency rates were 88.2% and 72.6%, and the 1- and 3-year major adverse limb event-free survival (MALE-FS) rates were 82% and 57.4%. The 1- and 3-year survival rates were 92.9% and 76.2%, respectively. On multivariable Cox regression, aneurysm size, one-vessel runoff, and coverage below the knee were associated with a lower 3-year MALE-FS. Coverage below the knee was also associated with a lower 3-year MALE-FS. Other anatomic or technical details were not associated with limb-related events or patency. ConclusionsThis study is the largest single center analysis to describe the predictors of poor outcomes after EPAR. EPAR is a safe and effective way to treat popliteal artery aneurysms. Factors associated with poor MALE-FS after EPAR include single-vessel tibial runoff and coverage below the knee.

Adherence to instruction for use after endovascular repair of popliteal artery aneurysm.

Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. The two groups of patients treated within (n = 10) and not within (n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU (n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17-2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018-2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.

Comparison of Outcomes for Open Popliteal Artery Aneurysm Repair Using Vein and Prosthetic Conduits

Autologous vein is considered the preferred conduit for lower extremity bypass. There is, however, limited literature regarding conduit choice for open popliteal artery aneurysm (PAA) repair. We sought to compare outcomes of PAA repair using vein versus prosthetic conduits. The Vascular Quality Initiative database (2003-2019) was queried for patients with PAAs undergoing elective conventional revascularization originating from the superficial femoral and popliteal arteries. Conduits were categorized as vein or prosthetic. Primary outcomes were primary graft patency, freedom from major adverse limb event (MALE) and MALE-free survival at 2-years. Kaplan-Meier method with log-rank tests was used for estimation and comparison of patency. A total of 1,146 limbs in 1,065 patients underwent elective open revascularization for PAA. Vein was used in 921 limbs (80%), and prosthetic in 225 (20%). Patients in the prosthetic cohort had a shorter procedure time, were older, and had a higher prevalence of COPD. Postoperatively, prosthetic patients were more likely to be started and maintained on anticoagulation without increased incidence of hematoma. There was no significant difference in the rate of surgical site infection (2% vs. 2%; P = 0.946). There was an increased tendency toward more symptomatic patients in the vein cohort although not statistically significant (49% vein vs. 41% prosthetic; P = 0.096). On a mean follow-up of 13 ± 5 months, the incidence of MALE and MALE-free survival were comparable between the two groups. The 2-year primary and secondary patency rates were similar, 87% and 96% in the vein, and 91% and 95% in the prosthetic groups, respectively. At multivariable analysis, outflow bypass targets to the infrapopliteal arteries (HR 2.05; 95% confidence interval (CI), 1.16-3.65; P = 0.014) and symptomatic aneurysm (HR 1.81; 95% CI, 1.04-3.15; P = 0.037) were independently associated with loss of primary patency. Conduit type did not make a difference in MALE-free survival, or primary graft patency at 2-years. Our study demonstrates that conventional open PAA repair with prosthetic conduit yields results comparable to those with vein conduit with regard to primary and secondary patency and MALEs at 2-years for targets to the popliteal artery. However, when the distal target was infrapopliteal, worse outcomes were observed with prosthetic conduit. Our results suggest that vein conduit should be preferentially used for infrapopliteal targets, while prosthetic conduit confers comparable outcomes in a subset of patients who do not have suitable autologous vein conduits.

Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort

To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 - 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 - 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Patients in the ER group were older (73 vs. 68 years, p= .001), had more lung disease (p= .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 - 4.55, p < .001) for ER, but 3.03 (1.26 - 7.27, p= .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 - 4.50, p= .003), but 4.68 (1.89 - 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 - 5.97], p= .003; and poor outflow HR 14.39 [3.46 - 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 - 0.93], p= .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 - 1.033], p= .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 - 2012 and 2014 - 2018). In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.

External stenting and disease progression in vein grafts 1 year after open surgical repair of popliteal artery aneurysm

ObjectiveOpen surgical repair remains the gold standard treatment for popliteal artery aneurysms (PAA). The objective of this study was to evaluate the safety of external stenting and its medium-term effect on vein graft disease after open PAA repair. MethodsBetween December 2017 and September 2019, 12 consecutive patients with PAA underwent open surgical repair with externally stented saphenous vein grafts. Duplex ultrasound scanning of the grafts was performed at discharge and at 3, 6, and 12 months after the procedure to evaluate graft patency, average lumen diameter and lumen uniformity. ResultsEleven patients underwent aneurysm ligation and bypass grafting and one patient was treated with aneurysm exclusion and interposition of a venous segment. External stenting of the vein graft was successful in all patients. The mean follow-up time was 12 months (range, 7-17 months), with a primary patency rate of 100% and no graft revisions or reinterventions. The mean lumen diameters at 3, 6, and 12 months were 5.9 ± 1.2 mm, 5.7 ± 0.8 mm, and 5.7 ± 0.7 mm, respectively, with no significant changes between 3 and 6 (P = .34) and between 6 and 12 months (P = .34). The coefficient of variance at 3, 6, and 12 months was 8.2 ± 9.3, 9.4 ± 7.2, and 10.4 ± 8.9, respectively, with no significant change between 3 and 6 months (P = .78) or 6 and 12 months (P = .98). No mortality or amputations were recorded throughout the follow-up period. ConclusionsExternal stenting of vein grafts in open surgical repair of PAA is feasible and safe. This technique may potentially improve the outcomes of surgical repair in patients with PAA.

Outcome of Endovascular Repair of Popliteal Artery Aneurysms using the Supera Stent

PurposeTo evaluate the efficacy of endovascular repair of popliteal artery aneurysms (PAAs) with a wire-interwoven nitinol stent. Materials and MethodsThis is a prospective, descriptive, and analytical study. From January 2016 to December 2018, 28 consecutive patients (29 lower limbs) were treated for a PAA with the deployment of the Supera stent (Abbott Vascular, Illinois). Twenty-three (79.3%) PAAs were asymptomatic; 6 (20.7%) presented with symptoms. The mean diameter and length of the aneurysm were 26.8 mm (20–40 mm) and 47.1 mm (23–145 mm) respectively. The primary endpoint was the prevention of embolic symptoms. The secondary endpoints were aneurysm exclusion, aneurysm diameter decrease, freedom from reintervention, and preservation of preoperative runoff vessels. ResultsTechnical success was 100%, with a median of 2.4 run-off vessels at completion angiography, without any loss of run-off vessels. A double Supera stent was deployed in 10 cases. At completion angiography, a median of 2.4 runoff vessels were present, without any loss of runoff vessels. The mean follow-up time was 24.3 (12–35) months. Primary endpoints were reached in 100% of the cases and vessels run off was preserved in all cases. In 2 PAAs, complete sac thrombosis was witnessed at 6-month follow-up, while at 12-month follow-up, it was seen in 10 of 29 (34.4%) limbs. In all the other cases the diameter of the aneurysm remained stable, with a freedom from sac enlargement of 100%. No fractures or stent thromboses were detected. ConclusionsFor endovascular repair of PAAs, the use of a thick interwoven-wire stent, that could work like a multilayer flow modulator showed encouraging mid-term results with no cases of stent fracture, occlusion or aneurysm increase.

Repair of Femoral and Popliteal Artery Aneurysms

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular). This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

Repair of Femoral and Popliteal Artery Aneurysms

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular). This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

Symptomatic type I endoleak following popliteal artery aneurysm repair.

A case of a symptomatic type Ib endoleak following popliteal artery aneurysm repair with successful interventional therapy introduces a short review of the limited literature to this relevant potential complication. Illustration of important factors supporting endoleak formation after endovascular popliteal artery repair and recommendation of a consequent surveillance are discussed.