Endovascular repair of popliteal aneurysms maintains significant sac shrinkage at five years

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Endovascular repair of popliteal artery aneurysm provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates, according to a study published in the August 2014 edition of the European Journal of Vascular and Endovascular Surgery. At five years of follow-up, limb salvage was 98%, survival rate was 84% and mean sac volume shrinkage from 45.5mL to 23mL.

The authors, led by Michele Piazza, Vascular and Endovascular Surgery Clinic of Padova University, Italy, stated that the aim of the study was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair. The study was a retrospective review of all endovascular repairs of popliteal aneurysm 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.

Forty-six endovascular repairs of popliteal aneurysms were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5±3.5mL). 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, three rest pain, and one compression symptoms).

Technical success was 98%. Mean duration of follow-up was 56±21 months. Primary patency at one, three, and five years was 82%, 79%, and 76%, while secondary patency was 90%, 85%, and 82%, respectively. At five 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 five-year post-procedure measurement was significant (45.5±3.5mL vs. 23±5mL; p<0.001). Segment coverage >20cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p=0.032).

Piazza et al write that although the results were positive for patency, limb salvage and survival, “close surveillance is nevertheless required, particularly during the first postoperative year”. They added that patients requiring long segment coverage (>20cm) may be at increased risk for failure.

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