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Home > Vascular Annual Meeting > maru_midterm_results

Mid-term Results of Endovascular Repair of Popliteal Artery Aneurysms with Covered Stents: The Significance of Run-off Score on Primary Patency

Sandip T. Maru, Paul Anain, Jr., Linda Harris, Maciej Dryjski, George R. Curl, Sonya Noor, Gregory Cherr, Purandath Lall, Hasan Dosluoglu.
State University of NY at Buffalo, Buffalo, N.Y.

OBJECTIVES: The availability of flexible covered stents coupled with its minimal invasiveness has resulted in a widespread use of this technology for repair of popliteal artery aneurysms (PAA). However, there is limited data with mid to long-term follow-up. The goal of this study was to review our mid-term results of endovascular PAA repair (EVPAR), and identify factors associated with improved primary patency (PP).

METHODS: All patients who underwent EVPAR using Viabahn between 2002-2007 at our University affiliated hospitals were reviewed. Kaplan-Meier analysis was performed for patency, limb salvage, and univariate and multivariate analyses were performed to identify factors associated with PP.

RESULTS: Fifty limbs (25 right) in 46 patients (92% males, mean age 71.6±10.2 (51-89) were treated. Mean aneurysm size was 3.0±0.7cm. The comorbidities, presenting symptoms are shown on Table 1. Primary technical success was 98%. Adjunctive thrombolysis was used in 18%. There were 2 or 3 patent runoff vessels in 66%. There was no 30-day mortality. Complications included asymptomatic occlusion (2%), MI (2%), DVT (2%), toe embolization (4%), pseudoaneurysm (2%). The median LOS was 2 days (mean 4.9±6.4 days). Mean follow-up was 24±14 months. Reocclusions occurred in 14 patients (10 asymptomatic). Three underwent successful thrombolysis, one required a below-knee amputation. Patency, and limb salvage rates are shown on Table 2I. PP was better in patients on clopidogrel (92±5% vs. 48±14%, p=0.003), 2-3 runoff vessels (93±5% vs. 52±13%, p=0.002) and without CAD (92±6% vs. 68±9%, p=0.023). Multivariate analysis showed only 2-3 vessel runoff being independently associated with improved PP (OR: 3.0 (95%CI: 1.0-9.2, p=0.05).

CONCLUSIONS: Our results show that EVPAR is safe with acceptable mid-term results. The PP appears to be inferior to the known results of open repair. However, due to its low morbidity and mortality, it should be the preferred treatment for high risk patients. Its role in low risk patients needs to be further defined in randomized trials. Our data, which represents the largest reported series from the U.S. suggest that patients with 2-3 vessel runoff without contraindication to clopidogrel seem to be ideal candidates for EVPAR.
AUTHOR DISCLOSURES: S.T. Maru, None; P. Anain, None; L. Harris, None; M. Dryjski, None; G.R. Curl, None; S. Noor, None; G. Cherr, None; P. Lall, None; H. Dosluoglu, None.