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

Zaghloul, Mohamed S.; Andraska, Elizabeth; Leake, Andrew; Chaer, Rabih A.; Avgerinos, Efthymios D.; Hager, Eric; Makaroun, Michel S.; Eslami, Mohammad H.

doi:10.1016/j.jvs.2020.12.062

Cited by 12 publications

(3 citation statements)

References 21 publications

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“…The Vascular Quality of Life Questionnaire ( 21 ), which evaluates health-related quality of life from domains of symptoms, pain, activities, social and emotional, is applied to quantify patient's quality of life. Major adverse events include disease-related mortality, major amputation, and acute vascular events that included myocardial infarction, ischemic stroke and acute limb ischemia ( 22 ).…”

Section: Methods and Analysismentioning

confidence: 99%

A prospective, multicenter, real-world observational study evaluating the impact of tibial runoff on clinical outcomes after endovascular therapy for femoropopliteal lesions: Research protocol

Liu

Wang

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCurrent evidence indicates endovascular intervention is a safe and effective treatment for peripheral artery disease of the lower extremity. However, the clinical outcome of endovascular intervention for femoropopliteal lesions has been shown to be affected by the status of tibial runoff. It remains unclear whether endovascular intervention for tibial runoff is associated with additional benefits.Methods and analysisThis prospective, multicenter, real-world observational study is carried out from January 2021 to December 2022 in 8 designated centers across China with an estimated sample size of 1200 patients with severe femoropopliteal disease. The pre-procedural status of tibial runoff is evaluated with the modified SVS score and categorized as good (SVS <5), compromised (SVS 5–10) or poor (SVS >10). Whether the patient will be treated with endovascular intervention for tibial runoff is determined by the treating vascular surgeons. Patients are dichotomized into the intervention group and the non-intervention group, with each group further divided into the good, compromised and poor tibial run-off subgroup, yielding 6 subgroups in total. Patients within various subgroups are compared with regard to the primary patency rate of the femoropopliteal artery, changes in quality of life, changes of Rutherford category, improvement of the Wound, Ischemia, and Foot Infection Classification, and incidence of major adverse events over 24-months follow-up. The results of this study may provide important information to help vascular sspecialists to decide whether the tibial runoff should be endovascularly intervened and which patient population benefits most from tibial runoff intervention.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04675632?id=NCT04675632&draw=2&rank=1, NCT04675632.

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Section: Methods and Analysismentioning

confidence: 99%

A prospective, multicenter, real-world observational study evaluating the impact of tibial runoff on clinical outcomes after endovascular therapy for femoropopliteal lesions: Research protocol

Liu

Wang

et al. 2022

Front. Cardiovasc. Med.

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“…31,32 In a recent large study of the long-term results of EPAR, the investigators found that aneurysm size, coverage below the knee, and singlevessel runoff were the only predictors of major adverse limb events. 61 Therefore, given the current data, for patients with poor tibial or pedal runoff, OPAR with GSV is considered preferential to EPAR for good-risk patients. High-risk patients, defined as those with a high cardiovascular risk or adverse anatomic criteria such as severe venous stasis or lymphedema, pose a challenge because the natural history of PAA is known only from purely retrospective data.…”

Section: Evidence To Decision Framework (Decisional Factors)mentioning

confidence: 99%

The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms

Farber

Angle

Avgerinos

et al. 2022

Journal of Vascular Surgery

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“…Moreover, an analysis of the follow-up data after treatment of popliteal aneurysm shows lower primary patency for endovascular treatment compared with open repair ( 6 , 7 ). However, the limb salvage rate is not different between the two groups ( 8 ); this could be explained by the slow occurrence of stent-graft thrombosis during follow-up, thus allowing the possibility of compensation circles supporting the limb salvage without the need for reinterventions.…”

Section: Introductionmentioning

confidence: 99%

Observational study of endoluminal mural thrombotic apposition in popliteal artery aneurysm stenting and its relationship with stent-graft geometrical features

Spinella,

Conti,

Magliocco

et al. 2023

Front. Cardiovasc. Med.

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IntroductionThe development of intrastent thrombosis is one of the mechanisms related to medium- to long-term failure of endovascular treatment of popliteal artery aneurysm. The present study aims to investigate possible links between the development of endoluminal mural thrombotic apposition in the stented zone (EMTS) with both geometrical features of stent-graft(s) and time of follow-up.MethodsPatients with popliteal artery aneurysm who underwent endovascular treatment were recruited during the follow-up period. Segmentation of computed tomography angiography scan was performed to detect femoropopliteal artery lumen, leg bones, EMTS, and stent-graft(s). The following parameters were assessed: number, diameter, and length of stent-graft(s); and shape, volume, and length of thrombotic apposition within the stent(s). The spiral shape of the thrombotic apposition was evaluated as well.ResultsEighteen male patients were recruited in the study. EMTS was observed in 13 of them (72%) during the follow-up analysis. An average of 1.8 ± 0.79 stents-grafts were implanted per patient with a median diameter and length of 6.2 (1.9) mm and 125 (50) mm, respectively. The percentage of the stent length where EMTS was present was 42.1 on average (interquartile range: 42.4%) with a mean volume of 206.8 mm3. A positive correlation was found between the length and volume of EMTS (R-squared = 0.71, p < 0.01). Moreover, EMTS had a helical shape in 8/13 patients, with 4/5 with counterclockwise rotation with stent-grafts in the left leg and 3/3 with clockwise direction treated in the right leg. A higher frequency of EMTS was observed in patients with longer follow-up and higher risk factors, as well.ConclusionsEMTS is observed in most of the patients under analysis, especially in those with medium- to long-term follow-up. The pattern of such EMTS follows a helical shape having a direction that depends on which leg, right or left, is treated. Our results suggest a close surveillance of popliteal aneurysm stenting by follow-up examinations to control the onset and progression of EMTS.

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

Cited by 12 publications

References 21 publications

A prospective, multicenter, real-world observational study evaluating the impact of tibial runoff on clinical outcomes after endovascular therapy for femoropopliteal lesions: Research protocol

A prospective, multicenter, real-world observational study evaluating the impact of tibial runoff on clinical outcomes after endovascular therapy for femoropopliteal lesions: Research protocol

The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms

Observational study of endoluminal mural thrombotic apposition in popliteal artery aneurysm stenting and its relationship with stent-graft geometrical features

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