Hellwig Konstantin, Hoffmann Lisa, Rother Ulrich, Meyer Alexander, Lang Werner, Schmid Axel
Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
Ann Vasc Surg. 2020 Aug;67:370-375. doi: 10.1016/j.avsg.2020.03.006. Epub 2020 Mar 21.
Popliteal artery aneurysms (PAAs) are the most common peripheral aneurysms. Although rare and often asymptomatic, there is a significant risk of thrombosis, embolism, and limb loss. The aim of this study was to evaluate the eligibility for endovascular repair of patients treated for symptomatic and asymptomatic PAAs in accordance with the instructions for use (IFU).
All patients treated for PAA with open surgical repair between the years 2010 and 2017 were analyzed if suitable for endovascular treatment. Preoperative imaging was reviewed for applicability with an interventional radiologist and 2 vascular surgeons. Evaluation was performed in accordance with the following criteria adopted from the IFU of the Gore ® Viabahn stent graft: at least a single-vessel tibial runoff, proximal and distal landing zone more than 2 cm, no large difference in vessel diameter proximal and distal to the aneurysm, no overstenting of significant collaterals necessary, and no inadequate kinking of the artery. The patients were classified in 3 categories: the patient was eligible, endovascular treatment was feasible, and endovascular treatment was not appropriate.
51 patients with 61 symptomatic and asymptomatic PAAs were identified. Forty-five cases were asymptomatic, 11 cases showed clinical symptoms such as claudication, and in 5 cases, the patients presented with acute ischemia. Twenty-four patients were eligible for endovascular intervention, 14 cases were feasible, and in 23 cases, it was not appropriate in accordance with the IFU.
In this study, more than one-third of the patients with PAA were not eligible for endovascular treatment in accordance with the IFU and another 23 % showed substantial reasons against endovascular treatment. These data suggest that endovascular repair remains a treatment option for selected patients only. Cross-sectional imaging is mandatory for procedure selection.
腘动脉瘤（PAA）是最常见的周围动脉瘤。尽管罕见且通常无症状，但存在血栓形成、栓塞和肢体丧失的重大风险。本研究的目的是根据使用说明书（IFU）评估有症状和无症状PAA患者进行血管腔内修复的适用性。
分析2010年至2017年间接受开放手术修复PAA的所有患者是否适合血管腔内治疗。与一名介入放射科医生和两名血管外科医生一起复查术前影像以评估其适用性。根据从戈尔®Viabahn覆膜支架的IFU采用的以下标准进行评估：至少有单支胫动脉血流，近端和远端锚定区超过2 cm，动脉瘤近端和远端血管直径无大差异，无需对重要侧支进行过度覆膜，且动脉无过度扭曲。将患者分为三类：患者符合条件、血管腔内治疗可行、血管腔内治疗不合适。
确定了51例患者，共61个有症状和无症状的PAA。45例无症状，11例表现出如跛行等临床症状，5例患者表现为急性缺血。根据IFU，24例患者符合血管腔内干预条件，14例可行，23例不合适。
在本研究中，超过三分之一的PAA患者根据IFU不符合血管腔内治疗条件，另有23%显示出反对血管腔内治疗的充分理由。这些数据表明，血管腔内修复仍然只是特定患者的一种治疗选择。横断面成像对于手术选择是必需的。
