Endovascular treatment of popliteal artery aneurysms: is the technique a valid alternative to open surgery?
OBJECTIVE
Feasibility of endovascular repair of popliteal artery aneurysms has been established. The results of this technique and the effect of the learning curve on the occurrence of complications were evaluated in a prospective cohort.


METHODS
Between June 1998 and February 2007, 73 popliteal aneurysms were treated by endovascular means. Primary outcome was stent-graft patency. Secondary outcome was a combined end-point of stent-graft related complications, including occlusion, migration, stent-graft fracture, and stenosis. To study the learning curve, the cohort of patients was divided into 2 groups (group A from 1 to 23; group B from 24 to 73). Cut-off point chosen was the introduction of the more aggressive postoperative anticoagulation protocol with clopidogrel.


RESULTS
Eighteen (25%) stent-grafts occluded. This resulted in a reintervention in 11 patients. Migration, fracture, and stenosis were diagnosed in 9, 3 (2 leading to occlusion), and 2 limbs, respectively; these 14 complications accounted for reinterventions in 8 additional patients. In total, 19 of the 73 limbs (26%) required 20 reinterventions. Overall 3-and 5-year patency rates were 77% and 70% for primary patency, and 86% and 76% for secondary patency, respectively. There were more occlusions in group A (8/23, 35%) versus group B (10/50, 20%) (P= 0.22). With regard to the combined endpoint, there were more events in group A (14/23, 61%) than in group B (16/50, 32%) (P= 0.016).


CONCLUSIONS
Results of endovascular repair of popliteal artery aneurysms are improving and in range with those of open repair.
Tielliu
I F J
IF
Department of Surgery, University Medical Center Groningen,Groningen, The Netherlands. i.tielliu@chir.umcg.nl
Verhoeven
E L G
EL
Zeebregts
C J
CJ
Prins
T R
TR
Bos
W T G J
WT
Van den Dungen
J J A M
JJ
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000193:education / Q000295:instrumentation; D002983:Clinical Competence; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology* / Q000503:physiopathology; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000193:education