Serrano Hernando Francisco Javier, Martínez López Isaac, Hernández Mateo Manuela María, Hernando Rydings Manuel, Sánchez Hervás Luis, Rial Horcajo Rodrigo, Moñux Ducajú Guillermo, Martín Conejero Antonio
Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
J Vasc Surg. 2015 Mar;61(3):655-61. doi: 10.1016/j.jvs.2014.10.007. Epub 2014 Dec 9.
Surgical treatment of popliteal artery aneurysms (PAAs) has advanced over time. Constant development of new endovascular techniques has converted these into the most attractive methods available today. However, results for each endovascular procedure are still limited, and available data have emerged from studies examining only a small number of cases. The present retrospective review was designed to examine early and late results for PAA treatment and to identify possible factors associated with graft patency.
This was a retrospective review of all PAAs treated from January 1993 to December 2013. Symptomatic and asymptomatic PAAs >2 cm treated using open surgery or an endovascular procedure were included. Kaplan-Meier curves and the Breslow test were used to analyze data.
A total of 171 aneurysms were treated in 142 men (mean age, 69.3 years); of these, 53.3% were asymptomatic and 18.7% presented as acute ischemia. Saphenous vein was used for bypass in 57.9% of the patients, expanded polytetrafluoroethylene (ePTFE) in 23.4%, and a stent graft in 18.7%. In the open surgical group, a popliteal-popliteal bypass was performed in 37.4% and a distal anastomosis to a tibial vessel was required in 14.4%. Good runoff (two to three vessels) was present in 69%. Perioperative mortality (30 days) was 1.8%. Of eight early occlusions recorded, five (2.9%) underwent reoperations. Major amputations were needed in five patients (all with previous acute ischemia). Median follow-up for the entire cohort was 49 months (range, 1-228 months). Primary and secondary patency rates at 24, 36, and 60 months were 76.3% and 89.5%, 73.4% and 87.4%, and 68.3% and 80.9%, respectively. Popliteal-popliteal bypasses showed better primary patency at 24 months when saphenous vein was used vs ePTFE (94.9% vs 79%; P = .04); however, similar patency rates were recorded for short ePTFE bypasses and stent grafts (79% vs 79.7%). On multivariate analysis, only poor runoff emerged as an independent factor for worse primary patency (hazard ratio, 3.5; 95% confidence interval, 1.7-7.2; P = .001).
The open repair of PAA offers good long-term results, especially in asymptomatic patients, those undergoing elective surgery, and those showing good runoff. Given the also good midterm outcomes of endovascular treatment, this may be a feasible option in selected patients.
腘动脉瘤（PAA）的外科治疗随着时间不断发展。新的血管内技术不断涌现，使其成为目前最具吸引力的治疗方法。然而，每种血管内手术的效果仍然有限，现有数据仅来自少数病例的研究。本回顾性研究旨在探讨PAA治疗的早期和晚期结果，并确定与移植物通畅相关的可能因素。
这是一项对1993年1月至2013年12月期间治疗的所有PAA的回顾性研究。纳入采用开放手术或血管内手术治疗的直径>2 cm的有症状和无症状PAA。采用Kaplan-Meier曲线和Breslow检验分析数据。
共治疗171例动脉瘤，患者142例（平均年龄69.3岁）；其中53.3%无症状，18.7%表现为急性缺血。57.9%的患者采用大隐静脉搭桥，23.4%采用膨体聚四氟乙烯（ePTFE），18.7%采用覆膜支架。开放手术组中，37.4%进行了腘动脉-腘动脉搭桥，14.4%需要与胫血管进行远端吻合。69%有良好的血流（二至三支血管）。围手术期死亡率（30天）为1.8%。在记录的8例早期闭塞中，5例（2.9%）接受了再次手术。5例患者（均有既往急性缺血）需要进行大截肢。整个队列的中位随访时间为49个月（范围1 - 228个月）。24、36和60个月时的一期和二期通畅率分别为76.3%和89.5%、73.4%和87.4%、68.3%和80.9%。使用大隐静脉进行腘动脉-腘动脉搭桥在24个月时的一期通畅率优于使用ePTFE（94.9%对79%；P = 0.04）；然而，短段ePTFE搭桥和覆膜支架的通畅率相似（79%对79.7%）。多因素分析显示，仅血流不佳是一期通畅率较差的独立因素（风险比，3.5；95%置信区间，1.7 - 7.2；P = 0.001）。
PAA的开放修复提供了良好的长期效果，尤其是在无症状患者、接受择期手术的患者以及血流良好的患者中。鉴于血管内治疗也有良好的中期结果，这可能是部分患者的可行选择。
