Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. (November 2020)

• Record Type: Journal Article
• Authors: Grip, Olivia; Mani, Kevin; Altreuther, Martin; Bastos Gonçalves, Frederico; Beiles, Barry; Cassar, Kevin; Davidovic, Lazar; Eldrup, Nikolaj; Lattmann, Thomas; Laxdal, Elin; Menyhei, Gabor; Setacci, Carlo; Settembre, Nicla; Thomson, Ian; Venermo, Maarit; Björck, Martin
• Is Part Of: European journal of vascular and endovascular surgery. Volume 60:Number 5(2020)
• Page Start: 721
• Page End: 729
• Publication Date: 2020-11
• Subjects: Aneurysm – popliteal artery -- Endovascular -- Epidemiology -- Open surgery -- Registry; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2020.07.005
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. Methods: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). Results: During 2012–2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4–19.3). The mean age was 71.3 years (66.8–75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%–85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3–38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% ( n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture ( n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs . 0.7%; 1.9% vs . 0.5%). This pattern remained one year after surgery (8.5% vs . 1.0%; 6.1% vs . 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs . 0.2%; p = .095) but superior patency (84.0% vs . 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs . 72.3%; 1.8% vs . 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs . 1.6%, p = .009) than the medial approach. Conclusion: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.