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Anatomic Eligibility for Endovascular Popliteal Artery Aneurysm Repair
James R. Ballard, MD, Phong Dargon, MD, Marcus Kret, MD, Amir Azarbal, MD, Erica Mitchell, MD, Timothy Liem, MD, Gregory Landry, MD, Gregory Moneta, MD.
Oregon Health & Science University, Portland, OR, USA.
Objectives: Endovascular popliteal aneurysm repair (EPAR) is an alternative to open popliteal aneurysm (PA) repair. Anatomic restrictions limit suitability of EPAR, and the percentage of patients eligible for EPAR and whether eligibility is associated with PA related symptoms is not well documented. We reviewed patients who underwent PA repair to determine suitability or limitations of EPAR.
Methods: Patients with PAs from 1995 to 2011 were reviewed for demographics and clinical presentation. CT and angiographic images were reviewed to determine eligibility for EPAR. EPAR exclusion criteria were: single vessel runoff or stent placement that would result in single vessel runoff, SFA occlusion, PA thrombosis or rupture, and PA extension to the mid SFA or within 2 cm of the tibioperoneal trunk.
Results: Sixty-one patients presented with 111 PA. 50/ PAs (45%) had imaging sufficient to determine eligibility for EPAR and 64% (n=32) were symptomatic. Patients with and without sufficient imaging to determine EPAR eligibility had similar demographics and clinical characteristics. Of the 50 study PAs 20% had single vessel runoff, (40%) were occluded, and 18 (36%) met criteria for EPAR. More asymptomatic aneurysms (61%) were eligible for EPAR than symptomatic aneurysms (22%) (P=.006). Factors leading to noneligibility for EPAR (n=32) were single vessel runoff 31%, proximal aneurysm extension in 6.25%, distal extension 21.5%, PA occlusion 62.5%, requiring resection due to size of aneurysm 12.5%.
Conclusions: The majority of PA patients have anatomic restrictions currently prohibitive to EPAR. Open surgical repair is required in the majority of patients with symptomatic PA; however, EPAR may find broader application in asymptomatic patients.
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