Original title: A Multicentric Experience with Open Surgical Repair and Endovascular Exclusion of Popliteal Artery Aneurysms. Reference: R. Pulli et al. European Journal of Vascular and Endovascular Surgery, Volume 45, Issue 4, Pages 357-363.
Complications of a popliteal aneurysm may cause rupture, distal embolization or thrombosis with a risk of any of them affecting the lower limb. That’s why elective treatment of asymptomatic aneurysms larger than 20 mm is recommended. The surgery has good results although recently the possibility of endovascular stent graft exclusion has also emerged.
This retrospective multicenter registry analyzed the results of 312 popliteal aneurysms (178 treated with surgery and 134 endovascular) over a period of ten years.
The choice of strategy was at the discretion of the treating physicians, although there were clear differences especially in the clinical presentation. The 71% treated as endovascular were asymptomatic. The opposite was true for those who received surgical treatment where 64.5% were symptomatic of claudication or acute ischemia. In the endovascular group stent grafts were used, (Hemobahn or Viabahn, WL Gore & Associates Inc, Flagstaff, AZ, USA), implanted most frequently by ipsilateral access. In the surgical group thrombosis was observed in six patients (3.3%), three of which could be resolved but the other three required major amputation. After follow-up at 12, 24 and 48-months, primary patency of this group was 78.8%, 77.1% and 63.4% respectively. In the endovascular group seven patients developed thrombosis, (9.7%), all could be resolved except for one patient who required major amputation. Primary patency of endovascular treatment at 12, 24 and 48 months was 79.1%, 76.9% and 73.4% respectively.
Conclusion:
In this study, which has the highest record of popliteal aneurysms, surgical or endovascular treatment was used in different patients, preferring the surgical strategy for acute presentation and endovascular for asymptomatic. Both strategies showed good results in the short and long term.
Editorial comment:
You cannot directly compare the results of both strategies and the clinical presentation was often opposite. For the surgical group the results were better if used instead of autogenous vein graft. No randomized studies are currently available on this topic.
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