A Multicentric Experience with Open Surgical Repair and Endovascular Exclusion of Popliteal Artery Aneurysms

Pulli, Raffaele; Dorigo, Walter; Castelli, Patrizio; Dorrucci, Vittorio; Ferilli, Fiore; Blasis, Giovanni De; Monaca, Vincenzo; Vecchiati, Enrico; Benincasa, Anna Teresa; Pratesi, Carlo

doi:10.1016/j.ejvs.2013.01.012

Cited by 88 publications

(117 citation statements)

References 18 publications

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“…[31][32][33][34] Cases repaired with great saphenous vein grafts by conventional surgery have patency of 78.80% to 87.50% in the first year, with limb salvage rates of 94.30%. 20,26 Our patient sample was comparable with previous studies, with stent patency of 80% during the first year and limb survival of 100% over the first 90 days after ES, while cases treated with OS had 95.23% patency in the first month and 75% after 1 year, and a 90-day limb survival rate of 95.23%, including emergency cases. It is important to remember that in the cases treated with the endovascular technique, intraoperative arteriography showed at least two patent infrapatellar vessels, which indicates good blood flow drainage and contributes to the patency of the stents.…”

Section: Discussionsupporting

confidence: 72%

“…They accounted for 52.38% of the indications for repair using this technique, with an acceptable amputation rate (4.76% of all OS and 9% of urgent operations). A study by Pulli et al 26 reported that the majority of patients who underwent OS were symptomatic, compared with ES, although some studies report equal success rates for elective and emergency surgery. 27 The great majority report rates of complications and limb loss of 10% to 36% for patients who undergone emergency surgery, which are comparable to the rates for our patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Although the indications for repair of PAAs are not well defined, a diameter greater than 2 cm to 3 cm, especially for aneurysms with a significant thrombus load or with chronic distal tibial artery embolic occlusion, is an acceptable indication for intervention [11, 12]. Patients with severe claudication, resting pain, and tissue loss are considered for elective repair, as are patients who have symptoms of local compression.…”

Section: Discussionmentioning

confidence: 99%

Giant Popliteal Artery Aneurysm: Case Report and Review of the Literature

Verikokos

Karaolanis

Doulaptsis

et al. 2014

Case Reports in Vascular Medicine

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Popliteal artery aneurysms (PAAs) are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm, inflammatory arteritis, or popliteal entrapment are responsible. The authors report the first ever case of a male diagnosed with chronic renal failure with giant popliteal artery aneurysm. We have successfully resected the aneurysm and revascularized with synthetic graft.

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“…Few studies have directly compared outcomes after OPAR with EPAR and with different methodologies 4–9 and there is only one published, prospective, randomized trial that evaluated outcomes after OPAR and EPAR that included only 30 patients. 5 …”

Section: Introductionmentioning

confidence: 99%

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

Eslami

Doros

Goodney

et al. 2015

Annals of Vascular Surgery

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Background 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. Methods 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. Conclusions 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.

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A Multicentric Experience with Open Surgical Repair and Endovascular Exclusion of Popliteal Artery Aneurysms

Abstract: In this large multicentric retrospective registry, open and endovascular treatment of PAAs are used in different patients with regard to clinical and anatomical characteristics. Both treatments are feasible and safe, providing satisfactory early and long-term results.

Cited by 88 publications

References 18 publications

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

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

Giant Popliteal Artery Aneurysm: Case Report and Review of the Literature

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

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