title: Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion.
abstract: OBJECTIVE
  There are few long-term follow-up studies about the result of revascularization surgery for the treatment of popliteal artery entrapment syndrome (PAES). We performed this retrospective study to analyze the long-term result of revascularization surgery in patients with advanced PAES during the last 16 years.
  
  
  METHODS
  Twenty-two limbs in 18 consecutive patients with PAES were treated surgically at Seoul National University Hospital between January 1994 and December 2009. The preoperative diagnosis of PAES was made by duplex ultrasonography, three-dimensional computed tomography angiography, magnetic resonance imaging, or conventional angiography. The method of surgical approach was determined by the extent of arterial occlusion in preoperative images.
  
  
  RESULTS
  The mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015).
  
  
  CONCLUSIONS
  In advanced popliteal entrapment syndrome, longer bypass with superficial femoral artery inflow showed poor long-term graft patency rate. The graft patency rate was excellent in patients whose arterial occlusion was confined to the popliteal artery and treated by popliteal interposition graft with reversed saphenous vein. With these data, we suggest that longer bypass extending beyond the popliteal artery might only be indicated in patients with critical limb ischemia when the extent of disease does not allow short interposition graft.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seong-Yup
authors.initials: SY
authors.lastname: Kim
authors.forename: Seung-Kee
authors.initials: SK
authors.lastname: Min
authors.forename: Sanghyun
authors.initials: S
authors.lastname: Ahn
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Min
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D058017:Vascular Grafting / Q000009:adverse effects; D014654:Vascular Patency