Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm

Wrede, Axel; Wiberg, Frans; Acosta, Stefan

doi:10.1177/1538574417742762

Cited by 22 publications

(24 citation statements)

References 16 publications

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“…Amputation rates were reported in 10 of the included studies, 13,15,16,18,21,23,24,26 -28 revealing no significant differences in these rates between the OR and EVR groups (OR = 1.01; 95% CI: 0.55-1.85; P = .98).…”

Section: Resultsmentioning

confidence: 93%

“…Duration of hospitalization was reported in 12 of the included studies. 12,14,16,17,19,20,22,24,25,26 -28 An analysis of these studies indicated that EVR treatment was associated with a significant reduction in hospitalization duration relative to OR (mean difference = −3.71 days; 95%CI: −3.86 to −3.56; P < .000001). High heterogeneity was observed for the included studies with respect to this outcome ( I 2 = 94%).…”

Section: Resultsmentioning

confidence: 99%

“…In total, 17 of these 158 articles were found to meet the study inclusion criteria. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Patient and Trial Characteristics Table 1 summarizes the patient populations, interventions, and outcomes for each of the 17 individual studies, which incorporated 6603 patients in total. In total, 6887 PAA repair operations were conducted in these studies, including 5225 (75.87%) conducted via an OR approach and 1662 (24.13%) conducted via an EVR approach.…”

Section: Study Selectionmentioning

confidence: 99%

See 2 more Smart Citations

A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis

Tian

Yuan

Huang

et al. 2020

Vasc Endovascular Surg

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Objective: Traditionally, popliteal artery aneurysms (PPAs) were treated via open repair (OR). However, more recently endovascular repair (EVR) approaches have become more common for the treatment of PPAs. The present meta-analysis therefore sought to conduct an up-to-date review of studies comparing the relative safety and efficacy of these 2 repair strategies. To that end, patient outcomes including primary patency, operating time, hospital stay duration, and re-intervention, amputation, and graft occlusion within 30 days were compared for these OR and EVR approaches. Methods: Studies in which OR and EVR were compared as treatments for PPAs were identified through systematic searching of the PubMed and Embase databases. Any studies either analyzing only one of these treatments in isolation or analyzing <5 patients were not included in this analysis. For all relevant studies, patient demographic information and outcome details were compiled. Risk of bias was analyzed using a modified Newcastle-Ottawa Scale. The odds ratios, mean differences, and hazard ratios (HRs) for patient outcomes were estimated using a random-effects model. Results: In total, we identified 17 relevant studies including a single randomized controlled trial and 16 retrospective cohort studies, incorporating 6887 total cases (1662 EVR and 5225 OR). The quality of evidence for all measured outcomes was deemed to be very low or low according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Rates of primary patency were found to be significantly higher for patients treated via OR relative to those treated via EVR (HR = 1.60; 95% confidence interval [CI]: 1.12-2.30; P = .03). Operative and hospitalization durations, in contrast, were significantly lower for patients treated via EVR. Patients treated via EVR also experienced significantly higher rates of graft thrombosis and reintervention within 30 days relative to patients treated via OR. However, no significant differences were observed between treatments with respect to rates of patient amputation (OR = 1.01; 95% CI: 0.55-1.85; P = .98). Conclusions: The available data suggest that PPA repair via EVR is a safe alternative to OR, but that short-term graft thrombosis and reintervention rates are significantly greater for the former approach. Moreover, few studies to date have compared these techniques and those that were largely retrospective in nature with relatively low-quality evidence, making it difficult to make definitive statements regarding the relative safety and efficacy of these 2 repair strategies. Additional population-based large-scale studies are therefore essential in order to conduct a robust evaluation of the safety and utility of EVR as an alternative to OR for PPA repair.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

See 1 more Smart Citation

A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis

Tian

Yuan

Huang

et al. 2020

Vasc Endovascular Surg

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“…An increasing proportion of popliteal artery aneurysms are found and operated because of screening for AAA. 9 These scenarios have not been taken into account in the debate about the benefits and harms of AAA screening.…”

Section: Response To the Ebola Virus Disease Outbreak In The Democratmentioning

confidence: 99%

Response to the Ebola virus disease outbreak in the Democratic Republic of the Congo

Nkengasong

Onyebujoh

2018

The Lancet

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“…1 In elective cases, open or endovascular treatment is often used when the aneurysm reaches 2 cm in diameter. 2 Results of endovascular treatment were initially disappointing, likely due to the materials used in the first generation of devices, 3 and while it continues to demonstrate lower patency rates compared with open repair using prosthetic materials or autologous vein, 4 endovascular PAA repair is now indicated in selected cases. 5 In particular, it is often used in the absence of arterial tortuosity and off-target area dilatation and when treating patients with at least 2 runoff vessels and proximal and distal stent-graft landing zones of at least 15 mm.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Morphological Changes of the Femoropopliteal Arteries due to Knee Flexion After Endovascular Treatment of Popliteal Aneurysm

et al. 2019

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Purpose: To evaluate morphological changes of the femoropopliteal (FP) arteries due to limb flexion in patients undergoing endovascular treatment of popliteal artery aneurysms (PAAs). Materials and Methods: Seven male patients (mean age 68 years) underwent endovascular treatment of PAA with a Viabahn stent-graft between January 2013 and December 2017. During follow-up, one contrast-enhanced computed tomography angiography (CTA) scan of the lower limbs was acquired for each recruited patient. A standardized CTA protocol for acquisitions in both straight-leg and bent-leg positions was used to visualize changes in artery shape due to limb flexion. Three-dimensional reconstruction of the FP segment was performed to compute mean diameter and eccentricity of the vascular lumen and to measure length, tortuosity, and curvature of the vessel centerline in 3 arterial zones: (A) between the origin of the superficial femoral artery and the proximal end of the stent-graft, (B) within the stent-graft, and (C) from the distal end of the stent-graft to the origin of the anterior tibial artery. Results: After limb flexion, all zones of the FP segment foreshortened: 6% in zone A (p=0.001), 4% in zone B (p=0.001), and 8% in zone C (p=0.07), which was the shortest (mean 4.5±3.6 cm compared with 23.8±5.7 cm in zone A and 23.6±7.4 cm in zone B). Tortuosity increased in zone A (mean 0.03 to 0.05, p=0.03), in zone B (0.06 to 0.15, p=0.005), and in zone C (0.027 to 0.031, p=0.1). Mean curvature increased 15% (p=0.05) in zone A, 27% (p=0.005) in zone B, and 95% (p=0.06) in zone C. In all zones, the mean artery diameter and eccentricity were not significantly affected by limb flexion. Conclusion: Limb flexion induces vessel foreshortening and increases mean curvature and tortuosity of the FP segment both within and outside the area of the stent-graft.

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Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm

Abstract: The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.

Cited by 22 publications

References 16 publications

A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis

A Comparison of Endovascular Versus Open Repair of Popliteal Artery Aneurysms: An Updated Meta-Analysis

Response to the Ebola virus disease outbreak in the Democratic Republic of the Congo

In Vivo Morphological Changes of the Femoropopliteal Arteries due to Knee Flexion After Endovascular Treatment of Popliteal Aneurysm

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