Endovascular Treatment of Popliteal Artery Aneurysms Has Comparable Long Term Outcomes to Open Repair with Shorter Length of Stay
Brent Safran, MD, Noor Shah, MD, Rae Rokosh, MD, Thomas Maldonado, MD, Mikel Sadek, MD, Karan Garg, MD, Glenn Jacobowitz, MD, Frank Veith, MD, Caron Rockman, MD, Neal Cayne, MD
NYU Langone, New York, NY
OBJECTIVE
While open surgical repair (OR) of popliteal artery aneurysms (PAAs) remains the gold standard for treatment, endovascular repair (ER) has become an increasingly attractive alternative in select patients. The objective of this study was to compare the outcomes of OR versus ER of PAAs at a single institution.
METHODS
A retrospective chart review was performed from 1998 to 2013. Consecutive patients with PAAs who underwent OR or ER were identified. Patient demographics, aneurysm characteristics, operative findings and outcomes were compared. The choice of therapy was at the discretion of the surgeon.
RESULTS
A total of 64 patients underwent repair of 79 PAAs. Twenty-nine patients with 33 PAAs underwent OR, and 35 patients with 40 PAAs underwent ER. There were no statistically significant differences in patient demographics, aneurysm characteristics, symptomatology, run-off vessels or survival. There were no peri-procedural deaths. Two patients in the ER group required same-day re-interventions for peri-procedural complications. Mean follow-up for OR and ER was 94 and 42 months, respectively. Length of stay (LOS) was significantly shorter with ER (1.8 days) compared to OR (5.4 days) (p=0.012). Primary patency in the OR and ER cohorts at one year were 90.9% and 85%, respectively (p = NS), and 75.8% and 82.5%, (p = NS), at 3 years. Secondary patency at 3 years was equivalent at 100%. The re-intervention rates in the OR and ER groups were 30.3% and 17.5%, respectively (p=NS). In the ER group, poor runoff (≤1 vessel) was associated with a 36.4% re-intervention rate, compared to 10.3% in patients with good run-off (>1 vessel) (p=NS). Two patients with OR required a major amputation, at 3 and 12 years, respectively, compared to zero patients with ER (p=NS).
CONCLUSIONS
The results of this study do not demonstrate a statistically significant difference in long-term primary patency rate between OR and ER. However, there was a trend towards poor run-off being a negative predictor of graft patency in ER. In addition, there was a shorter LOS and a trend towards decreased rates of limb loss with ER. In conclusion, ER of PAAs may be a safe and durable alternative to OR, especially in patients with suitable tibial anatomy.
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