title: Long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair.
abstract: OBJECTIVE
  The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair (EVPAR).
  
  
  METHODS
  This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan-Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis.
  
  
  RESULTS
  Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases (n = 43) the procedure was elective, while in 7% of cases it was for rupture (n = 2) or acute thrombosis (n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p < .001). Segment coverage >20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p = .032).
  
  
  CONCLUSIONS
  EVPAR provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure.
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy. Electronic address: mikpia79@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Menegolo
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bonvini
authors.affiliation: NorthSide Heart and Vascular Institute, Atlanta, GA, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Ricotta
authors.affiliation: Vascular Surgery Clinic, Udine Hospital, Udine, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Frigatti
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Grego
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Antonello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Endovascular repair; Popliteal artery aneurysm; Sac volume measures