Department of Vascular Surgery, West Virginia University, Charleston, WVa 25304, USA.
J Vasc Surg. 2013 May;57(5):1306-10. doi: 10.1016/j.jvs.2012.10.122. Epub 2013 Jan 30.
Over the past decade, the treatment of popliteal aneurysms has evolved at our institution from sole operative intervention during the initial part of the study period, to combined surgical and endovascular treatment, and finally to endovascular-centered management in more recent years.
This is a retrospective review of all patients with popliteal aneurysms treated at our institution from 2001 to 2011. Data collection included the indication for intervention, treatment details, interventional patency, limb salvage, perioperative outcome, and midterm survival.
Eighty-eight aneurysms (72 patients) were treated during this period. Indications for intervention included symptomatic presentations in 53% (n = 47) and asymptomatic in 47% (n = 41). Treatment included endovascular exclusion in 24, surgical repair in 63 (14 posterior approach and 49 medial approach with bypass and exclusion), and primary amputation in one patient. Nine aneurysms (10.2%) received catheter-directed thrombolysis. Demographics were similar between the two treatment cohorts, except for age with endovascular stenting patients being significantly older (76.0 vs 66.0 years; P = .002). The mean length of stay was 3.9 days vs 9.5 days (P < .001), favoring endovascular treatment. There were no perioperative (30-day) deaths in the endovascular group and one in the surgical cohort. The mean patency follow-up was 21.2 vs 28.3 months. Primary patency did not differ between endovascular and surgically treated patients at 1 year (92.9% vs 83.3%; P = .26) and 3 years (63.7% vs 77.8%; P = .93). No limbs were lost in the endovascular group during the follow-up period of 22.4 months, and one late limb loss occurred in the surgical cohort (mean follow-up, 29.2 months). Endovascular patients had a midterm survival rate of 65% (mean follow-up, 33.9 months), whereas surgical patients experienced a survival rate of 80.8% (mean follow-up, 42.9 months; P = .22).
Endovascular treatment of popliteal aneurysms provides similar short-term patency to that of the traditional gold standard approach with surgical bypass, with shorter hospitalizations in both symptomatic and asymptomatic patients. Further long-term follow-up is required to compare these two treatment modalities for durability to determine the optimal popliteal aneurysm management.
在过去的十年中，我们机构对腘动脉瘤的治疗方法发生了演变，从研究初期的单纯手术干预，到联合手术和血管内治疗，再到近年来以血管内治疗为中心的治疗方法。
这是对 2001 年至 2011 年在我们机构治疗的所有腘动脉瘤患者进行的回顾性研究。数据收集包括干预指征、治疗细节、介入通畅性、肢体保留、围手术期结果和中期生存率。
在此期间，共治疗了 88 个动脉瘤（72 例患者）。干预指征包括有症状的 53%（n=47）和无症状的 47%（n=41）。治疗包括血管内闭塞 24 例，手术修复 63 例（14 例后路，49 例经内侧入路旁路和闭塞），1 例患者行截肢术。9 个动脉瘤（10.2%）接受了导管内溶栓治疗。两组患者的一般资料相似，仅血管内支架置入患者的年龄显著较大（76.0 岁比 66.0 岁；P=0.002）。血管内治疗组的平均住院时间为 3.9 天，而手术组为 9.5 天（P<0.001）。血管内组围手术期（30 天）无死亡，手术组有 1 例死亡。平均随访 21.2 个月和 28.3 个月，随访期内血管内治疗和手术治疗患者的通畅率无差异。1 年时，血管内治疗组和手术治疗组的通畅率分别为 92.9%和 83.3%（P=0.26），3 年时分别为 63.7%和 77.8%（P=0.93）。血管内治疗组在 22.4 个月的随访期内无一例肢体丢失，手术组有 1 例肢体丢失（平均随访时间 29.2 个月）。血管内治疗组的中期生存率为 65%（平均随访时间 33.9 个月），手术治疗组为 80.8%（平均随访时间 42.9 个月；P=0.22）。
血管内治疗腘动脉瘤的短期通畅率与传统的旁路手术金标准相似，且对有症状和无症状患者均具有较短的住院时间。需要进一步的长期随访来比较这两种治疗方法的耐久性，以确定最佳的腘动脉瘤治疗方法。
