Treatment of Popliteal Aneurysm by Open and Endovascular Surgery: A Contemporary Study of 592 Procedures in Sweden.
BACKGROUND
Popliteal aneurysm (PA) is traditionally treated by open repair (OR). Endovascular repair (ER) has become more common. The aim was to describe time trends and compare results (OR/ER).


METHODS
The Swedish vascular registry, Swedvasc, has a specific PA module. Data were collected (2008-2012) and supplemented with a specific protocol (response rate 99.1%). Data were compared with previously published data (1994-2002) from the same database.


RESULTS
The number of operations for PA was 15.7/million person-years (8.3 during 1994-2001). Of 592 interventions for PA (499 patients), 174 (29.4%) were treated for acute ischaemia, 13 (2.2%) for rupture, 105 (17.7%) for other symptoms, and 300 (50.7%) were asymptomatic (31.5% were treated for acute ischaemia, 1994-2002, p = .58). There were no differences in background characteristics between OR and ER in the acute ischaemia group. The symptomatic and asymptomatic groups treated with ER were older (p = .006, p < .001). ER increased 3.6 fold (4.7% 1994-2002, 16.7% 2008-2012, p = .0001). Of those treated for acute ischaemia, a stent graft was used in 27 (16.4%). Secondary patency after ER was 70.4% at 30 days and 47.6% at 1 year, versus 93.1% and 86.8% after OR (p = .001, <.001). The amputation rate at 30 days was 14.8% after ER, 3.7% after OR (p = .022), and 17.4% and 6.8% at 1 year (p = .098). A stent graft was used in 18.3% for asymptomatic PA. Secondary patency after ER was 94.5% at 30 days and 83.7% at 1 year, compared with 98.8% and 93.5% after OR (p = .043 and 0.026). OR was performed with vein graft in 87.6% (395/451), with better primary and secondary patency at 1 year than prosthetic grafts (p = .002 and <.001), and with a posterior approach in 20.8% (121/581).


CONCLUSIONS
The number of operations for PA doubled while the indications remained similar. ER patency was inferior to OR, especially after treatment for acute ischaemia, and the amputation risk tended to be higher, despite similar pre-operative characteristics.
Uppsala University, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; NU-Hospital Organisation, Trollhättan/Uddevalla, Sweden.
A
A
Cervin
Uppsala University, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; NU-Hospital Organisation, Trollhättan/Uddevalla, Sweden.
J
J
Tjärnström
Uppsala University, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; Department of Vascular Surgery, Lillebaelt Hospital, Denmark.
H
H
Ravn
Vascular Centre, Malmö University Hospital, Sweden.
S
S
Acosta
Department of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden.
R
R
Hultgren
Department of Vascular Surgery, Linköping University, Linköping, Sweden.
M
M
Welander
Uppsala University, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden. Electronic address: martin@bjorck.pp.se.
M
M
Björck
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
Amputation; Endovascular; Open repair; Popliteal artery aneurysm; Registry; Stent graft