title: The value of duplex surveillance after open and endovascular popliteal aneurysm repair.
abstract: OBJECTIVE
  The objective of this study was to determine the clinical value of vascular laboratory surveillance after open or endovascular repair of popliteal aneurysm by analysis of the frequency and nature of secondary interventions performed.
  
  
  METHODS
  Over an 8-year period, 55 popliteal artery aneurysms were repaired in 46 men (mean age, 72 years) by aneurysm ligation and bypass grafting (vein, 37; prosthetic, 7), endoaneurysmorrhaphy and interposition grafting (prosthetic, 3; vein, 1), or endograft exclusion (n = 7). Indications for intervention included aneurysm thrombosis with critical limb ischemia (n = 8), symptomatic (n = 10) or asymptomatic (n = 37), >1.75 cm popliteal aneurysm with mural thrombus. Catheter-directed thrombolysis was used in three limbs to restore aneurysm and tibial artery patency before open repair. Duplex ultrasound surveillance was performed after repair to identify residual and acquired lesions. Life-table analysis was used to estimate repair site intervention-free (primary) and assisted-primary patency.
  
  
  RESULTS
  During a mean 20-month follow-up interval, 20 secondary procedures were performed in 18 (31%) limbs to repair duplex-detected graft stenosis (n = 10), repair site thrombosis (n = 5), vein graft aneurysm (n = 3), graft entrapment (n = 1), or type 1 endoleak (n = 1). Primary patency was 76% and 68% at 1 and 3 years, and was uninfluenced by tibial artery runoff status or type of bypass conduit. Open (n = 12) or endovascular (n = 8) secondary procedures were performed on 15 (12 vein, 3 prosthetic) bypass grafts, 2 endografts, and 1 interposition graft. Mean time to repair graft stenosis (11 months) was shorter than to repair of vein graft aneurysm (37 months). Assisted-primary patency was 93% and 88% at 1 and 3 years; redo bypass grafting was required and successful in five limbs. Limb salvage was 100%.
  
  
  CONCLUSIONS
  One third of popliteal artery aneurysms repaired by open or endovascular procedures required a secondary intervention within 2 years of repair. Repair-site surveillance using duplex ultrasound was able to identify lesions that threaten patency, which resulted in excellent assisted patency and limb preservation rates when corrected.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of South Florida College of Medicine, Tampa, USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Paul A
authors.initials: PA
authors.lastname: Armstrong
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Bandyk
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Flaherty
authors.forename: Murray L
authors.initials: ML
authors.lastname: Shames
authors.forename: Brad L
authors.initials: BL
authors.lastname: Johnson
authors.forename: Martin R
authors.initials: MR
authors.lastname: Back
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014656:Vascular Surgical Procedures