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Publication
Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: a Vascunet Report
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Advisor(s)
Abstract(s)
Objective: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes.
Methods: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland).
Results: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach.
Conclusion: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.
Description
Keywords
HSM CIR VASC Humans Aged Male Female Middle Aged Acute Disease / epidemiology Acute Disease / therapy Amputation, Surgical / statistics & numerical data Aneurysm / complications Aneurysm / epidemiology Aneurysm / pathology Aneurysm / surgery* Australia / epidemiology Brazil / epidemiology Elective Surgical Procedures / adverse effects Elective Surgical Procedures / methods Elective Surgical Procedures / statistics & numerical data Endovascular Procedures / adverse effects Endovascular Procedures / methods Europe / epidemiology Incidence Global Burden of Disease Ischemia / epidemiology Ischemia / etiology Ischemia / surgery* Limb Salvage / adverse effects Limb Salvage / methods Limb Salvage / statistics & numerical data* New Zealand / epidemiology Popliteal Artery / pathology* Popliteal Artery / surgery Prospective Studies Risk Factors Registries / statistics & numerical data Retrospective Studies Thrombosis / epidemiology Thrombosis / etiology Thrombosis / surgery* Treatment Outcome Vascular Grafting / adverse effects Vascular Grafting / methods Vascular Grafting / statistics & numerical data Vascular Patency
Citation
Eur J Vasc Endovasc Surg . 2020 Nov;60(5):721-729.