Surgical technique and long-term results after popliteal artery aneurysm repair: Results from 717 legs

Ravn, Hans; Wanhainen, Anders; Björck, Martin

doi:10.1016/j.jvs.2007.04.018

Cited by 110 publications

(103 citation statements)

References 26 publications

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“…Thus, we focused on the differences in the outcomes between these two management protocols. The rate of remnant sac enlargement after ligation with bypass was 32% -35% in previous reports [3] [13] [14]. However, there were only 3 cases (6.8%) of sac enlargement in the present study.…”

Section: Discussioncontrasting

confidence: 63%

Outcomes of Open Surgery for Popliteal Artery Aneurysms: An 18-Year Experience in a Single Institution in Japan

Makino¹,

Hoshina²,

Yamamoto³

et al. 2018

WJCS

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Objective: To elucidate the outcomes of open surgery for popliteal artery aneurysm (PAA) in a single Japanese institution. Materials and Methods: Between 1999 and 2016, 35 patients (44 PAAs) underwent open surgery in our department. The first-line surgical strategy involved the medial approach, with excision of the aneurysm sac and autologous vein bypass grafting. Associations between the outcomes and 1) the surgical management of the aneurysmal sac (aneurysmectomy vs. ligation with bypass) and 2) the preoperative clinical symptoms were evaluated. Results: There were no aneurysm-related deaths during the follow-up period (mean, 4 years; range, 1 -17.6 years). The 5-year primary, primary-assisted, and secondary patency rates were 67.9%, 72.7%, and 94.5%, respectively. Re-intervention was required for 19 PAAs (14 patients), including two PAAs in patients with suspected Behçet's disease. Patency rates did not differ between the aneurysmectomy and ligation groups. Remnant sac enlargement occurred in 3 cases. Among asymptomatic patients, clinical symptoms did not deteriorate; however, the ankle brachial pressure index decreased ≥0.15 in patients with artery-graft mismatching. Conclusion: Patency rates were good, and our modified ligation with bypass procedure, which involves excising the sac as much as possible, exhibited less risk in terms of remnant sac enlargement compared to that in previous studies.

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Section: Discussioncontrasting

confidence: 63%

Outcomes of Open Surgery for Popliteal Artery Aneurysms: An 18-Year Experience in a Single Institution in Japan

Makino¹,

Hoshina²,

Yamamoto³

et al. 2018

WJCS

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“…21 This compares with an amputation rate secondary to acute thrombosis due to popliteal aneurysms that is higher than 30% in some studies. 2,[22][23][24][25] In our case series, all of the patients who were operated on urgently (because of acute ischemia) underwent conventional surgery. 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).…”

Section: Discussionmentioning

confidence: 95%

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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“…The ligated aneurysm could still exhibit perfusion in patent side branches, such as geniculate collaterals, and this perfusion might increase the arterial pressure within the excluded PAA, causing aneurysm expansion and local complications, including neurovascular compression due to aneurysm expansion. 5,8 The postoperative enlargement of an aneurysm due to the ligation occurred in 22 -33% of cases in a previous study, and half of these enlarged aneurysms were associated with complications. 9 In our study group, 12 of 45 PAAs were treated by ligation and bypass surgery, and during the follow-up period, there was no aneurysm enlargement nor local complication.…”

Section: Years)mentioning

confidence: 89%

“…The second aim is to prevent the aneurysm expansion, leading to claudication, nerve compression or edema. 5 For this reason, elective repair of a PAA is recommended for all symptomatic PAAs and asymptomatic PAA larger than 20 mm, with mural thrombus. 6 The most common surgical technique used for the repair of a PAA is the medial approach with proximal and distal aneurysms ligation, combined with autologous vein or polytetrafluoroethylene (PTFE) bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, this technique does not exclude side branches with their origin in the PAA, which may be responsible for continued retrograde perfusion in the ligated aneurysm, which can eventually lead to aneurysm enlargement. 5,8 An alternative technique is the posterior approach. This technique with interposition graft reconstruction and oversewing of the patent side branches of the genicular arteries should prevent aneurysm perfusion.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms

Igari

Kudo

Toyofuku

et al. 2016

International Surgery

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Abstract:Purpose:The aim of this study was to evaluate the long-term outcomes of the surgical repair of popliteal artery aneurysms (PAAs), and to analyze the factors associated with graft patency. Methods: Between January 1980 and December 2013, forty-five limbs were subjected to open surgical repair at Tokyo Medical and Dental Hospital. We retrospectively examined the patients' clinical characteristics, clinical symptoms, and aneurysm-related anatomy. Surgical procedures were performed through a posterior or medial approach with using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative-mortality, postoperative-morbidity, graft patency, and limb salvage. Results: During the study period, forty-five limbs [35 patients, mean age: 60 years] were subjected to open surgical repair. 25 limbs were treated through a posterior approach with using 23 autologous vein grafts (AVGs), and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach with using 13 AVGs, and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at one, three and five years were 88.0%, 75.7% and 75.7%, respectively, and the limb salvage rates at one, three and five years were 97.1%, 91.4% and 91.4%, respectively. In the univariate analysis, the ligation and bypass grafting affected the primary patency rate significantly, and the ePTFE graft was associated with a poor primary patency in the multivariate analysis (hazard ratio: 17.8). Conclusion:The use of resection or endoaneurysmorrhaphy for PAAs and graft interposition with an AVG might be more effective for the open repair of PAAs.

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Surgical technique and long-term results after popliteal artery aneurysm repair: Results from 717 legs

Abstract: The risk of late amputation was higher with prosthetic grafts. Operation with a posterior approach decreased the risk of expansion.

Cited by 110 publications

References 26 publications

Outcomes of Open Surgery for Popliteal Artery Aneurysms: An 18-Year Experience in a Single Institution in Japan

Outcomes of Open Surgery for Popliteal Artery Aneurysms: An 18-Year Experience in a Single Institution in Japan

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

Long-Term Results of Surgical Treatment of Popliteal Artery Aneurysms

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