Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP

Abstract

Background: popliteal artery aneurysms (PAAs) account for 70% of peripheral aneurysms. Surgery is indicated for aneurysms that have diameters greater than 2.0 cm or are symptomatic. Repair can be achieved by conventional surgical techniques or using endovascular methods, which are becoming increasingly popular, but for which there is not yet a consensus on indications. Objective: To describe the experience of treating PAAs at the vascular and endovascular surgery department of the Hospital das Clínicas de Ribeirão Preto, affiliated to the Universidade de São Paulo (Brazil). Method: A review was conducted of cases of conventional and endovascular repair of PAAs over the last 5 years, analyzing demographic data, comorbidities, surgical indications, preoperative and early and late postoperative complications, length of hospital stay and patency, during follow-up of up to 1 year. Results: During the period analyzed, ten endovascular surgeries (ES) and 21 open surgeries (OS) were performed. The ES group exhibited a higher frequency of comorbidities. There was a higher frequency of symptomatic patients in the OS group (85%) than in the ES group (40%). The ES group exhibited a lower number of clinical and surgical complications. There were no statistical differences between the groups in terms of age or length of hospital stay. Primary patency at 1 year was 80% in the ES group and 75% in the OS group. Conclusions: Endovascular treatment for PAAs offers good results in terms of patency, with acceptable complication rates, in patients with high surgical risk and favorable anatomy. Controlled studies are therefore warranted to validate the endovascular technique and afford it the status of an alternative procedure for use in selected cases.

Tratamento endovascular versus tratamento aberto de aneurisma de artéria poplítea: artigo de revisão

“…The six articles describing retrospective studies were published by Pulli et al, 15 Huang et al, 16 Serrano Hernando et al, 17 Ronchey et al, 18 Cervin et al, 19 and Braga et al, 13 and are summarized in Tables 1 and 2. The metanalyses used were conducted by von Stumm et al, 20 published in 2015 and combining a total of 652 cases, and by Leake et al, 21 published in 2017, covering 14 studies and 4,880 PAA treatments.…”

“…Braga et al 13 reported 5 years' experience at the Hospital das Clínicas de Ribeirão Preto. Endovascular treatment using Viabahn  covered stents (a mean of 1.6 stents per patient) was chosen for patients at high surgical risk, with a minimum of two patent distal vessels, and proximal and distal necks of at least 1 cm.…”

“…11,12 By-pass is the preferred technique, with a medial approach, proximal and distal ligature of the aneurysm, and inverted great saphenous vein graft. 13 In 1994, Marin et al 14 reported the first case of endovascular treatment (ET) for PAA. This promising treatment is less invasive, requires shorter duration surgery and involves less blood loss, and can also be performed with local anesthesia and, as a consequence, hospital discharge and recovery occur earlier.…”

Comparação entre cirurgia aberta e endovascular no tratamento do aneurisma da artéria poplítea: uma revisão

“…Fifteen articles were analyzed, published between 2005 and 2016 and comparing open surgery and endovascular surgery for treatment of PAAs. Thirteen of these articles were non-randomized studies [9][10][11][12][13][14][15][16][17][18][19][20][21] ; there was just one randomized clinical trial 22 and one comparative prospective study which followed up on the series studied by this randomized clinical trial. 23 The difficulty of establishing an adequate evidence level for any recommendation on treatment approach for PAAs is therefore clear.…”

Tratamento de aneurisma de artéria poplítea bilateral

“…Comparative studies have shown primary patency rates in the range of 86.6 to 95.0% for endovascular techniques and 78.8 to 87.5% for open surgery using the saphenous vein as graft. 25 However, the 30 and 90-day reintervention rates after the initial endovascular procedure are considerably higher than after open surgery. 24…”