Bracale Umberto Marcello, Corte Giuseppe, Di Gregorio Antonella, Pecoraro Felice, Machì Pietro, Rusignuolo Filippo, Bajardi Guido
Department of Vascular and Endovascular Surgery, University of Palermo, Palermo, Italy.
Ann Ital Chir. 2011 Nov-Dec;82(6):443-8.
Endovascular popliteal artery aneurysm repair has emerged recently as a feasible alternative to standard surgical repair. However, the evidence from the literature is still limited, with only case reports, case series and one small randomized trial. Currently, the available data suggests that stent-grafts should be used in patients at very high surgical risk. The purpose of this study is to present our surgical experience in popliteal artery aneurysm repair in an endovascular era.
Data from 36 consecutive patients, who were admitted to our hospital from January 2000 to April 2010, was analyzed retrospectively. Twenty-six patients underwent surgical treatment through medial or posterior access. The posterior approach was used preferentially. The medial approach was adopted in patients with large aneurysms or aneurysms involving the superficial femoral artery.
Twelve patients (Group A; 46.1%) were operated on via medial access followed by femoropopliteal bypass. In the remaining fourteen patients (Group B; 53.9%) an interposition graft was performed via a posterior approach. The 30-day overall mortality rate was 3.8% (1/26). The 30-day amputation rate was 0% in both groups. The primary patency rate was 83.3% in Group A at 78.8-month average follow-up (range: 18-128 months) and was 100% in Group B at 46.3-month average follow-up (range: 5-121 months).
Notwithstanding the extensive use of stent-grafts worldwide, surgical repair remains the gold standard for the management of popliteal artery aneurysms. In our experience open repair using either a medial or posterior approach is associated with low mortality and morbidity rates.
