Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Vasc Surg. 2018 Jun;67(6):1797-1804. doi: 10.1016/j.jvs.2017.09.040. Epub 2017 Dec 29.
The position of endovascular treatment in the algorithm of popliteal artery aneurysm (PAA) repair is still a matter of debate. Although several studies have described results similar to those of open surgery, follow-up of the endovascular group has been relatively short so far. The aim of this study was to describe the long-term outcome of endovascular repair of PAA with endografts.
All patients with a PAA treated with an expanded polytetrafluoroethylene stent graft between June 1998 and November 2014 in a tertiary referral center were prospectively gathered in a database and retrospectively analyzed. The primary end point of this study was primary patency. Secondary end points included primary assisted and secondary patency, survival of the patient, stent fractures, secondary interventions, and limb loss.
A total of 75 PAAs were treated in 64 patients with a mean age of 68.1 ± 9.4 years. Unilateral PAA was present in 39 patients (61%) and bilateral PAAs in 25 patients (39%), of which 11 (17%) were treated bilaterally. Median follow-up was 68 months (range, 2-187 months). Primary patency at 1 year, 5 years, and 10 years was 84%, 60%, and 51%, respectively; primary assisted patency, 84%, 65%, and 57%; and secondary patency, 89%, 71%, and 60%. Stent fractures occurred in 28% of the cases (n = 21) in a median follow-up time of 47 months (range, 14-187 months). One-third of the fractures were associated with an occlusion that mainly presented with claudication, and only one was associated with acute ischemia. Reinterventions were performed in 12 cases (16%) during a median follow-up of 14 months (range, 1-47 months). The reintervention-free survival after 1 year, 5 years, and 10 years was 93%, 79%, and 79%, respectively. No major amputations were performed. The overall survival rate after 5 years and 10 years was 78% and 46%, respectively.
Endovascular repair has established a definitive role in the treatment protocol for PAAs. It is associated with acceptable long-term patency rates. Stent fractures occurred in almost one-third of cases but never led to limb loss. Future developments should focus on the design of more dedicated and durable stents for this specific indication.
血管内治疗在腘动脉瘤（PAA）修复算法中的地位仍存在争议。尽管已有几项研究描述了与开放手术相似的结果，但血管内组的随访时间相对较短。本研究的目的是描述使用带膜支架治疗 PAA 的长期结果。
在一家三级转诊中心，1998 年 6 月至 2014 年 11 月期间，前瞻性地收集了所有接受膨胀聚四氟乙烯支架治疗的 PAA 患者，并在数据库中进行了回顾性分析。本研究的主要终点是一期通畅率。次要终点包括一期辅助通畅率、二期通畅率、患者生存率、支架断裂、二次干预和肢体丧失。
共 64 例患者的 75 个 PAA 接受了治疗，平均年龄 68.1±9.4 岁。单侧 PAA 39 例（61%），双侧 PAA 25 例（39%），其中 11 例（17%）双侧 PAA 同时接受治疗。中位随访时间为 68 个月（范围：2-187 个月）。1 年、5 年和 10 年的一期通畅率分别为 84%、60%和 51%；一期辅助通畅率分别为 84%、65%和 57%；二期通畅率分别为 89%、71%和 60%。中位随访时间为 47 个月（范围：14-187 个月）时，支架断裂发生率为 28%（21 例）。三分之一的骨折与闭塞有关，主要表现为跛行，只有一例与急性缺血有关。12 例（16%）在中位随访 14 个月（范围：1-47 个月）时进行了再介入治疗。1 年、5 年和 10 年后的无再干预生存率分别为 93%、79%和 79%。没有进行主要截肢。5 年和 10 年后的总生存率分别为 78%和 46%。
血管内治疗在 PAA 的治疗方案中已确立了明确的地位。它具有可接受的长期通畅率。支架断裂发生率近三分之一，但从未导致肢体丧失。未来的发展应集中在为这一特定适应症设计更专用和更耐用的支架上。
