Treating Popliteal Artery Aneurysms

Popliteal artery aneurysms can be treated safely and successfully by open surgical repair or endovascular grafting, although the latter shows advantages in quicker recovery and shorter hospital stays, reported Michele Antonello, M.D., and colleagues.

Popliteal artery aneurysms (PAAs) account for 70%-80% of all peripheral artery aneurysms, reported Dr. Antonello and his associates in the department of vascular surgery at the University of Padua (Italy).

Surgical treatment for PAA is performed to isolate and exclude the aneurysm, prevent distal embolization, and permit revascularization. Symptomatic PAAs have a low limb salvage rate, compared with asymptomatic salvage. Open repair (OR)has been the traditional treatment, but endovascular grafting (ET)has recently become a valid alternative, according to the researchers.

The prospective, randomized clinical trial was carried out from 1999 to 2003 at a single center. Patients had an aneurysmal lesion in the popliteal artery with a diameter of at least 2 cm as detected by CT scan and with the proximal and distal neck of the aneurysm greater than 1 cm to allow fixation of the stent graft.

A total of 30 PAA treatments were performed on 26 patients (15 open repair surgeries using bypass and exclusion [OR] and 15 using endovascular therapy with a Hemobahn graft [ET]). The Hemobahn is a self-expanding nitinol stent, internally covered by an ultrathin polytetrafluoroethylene (PTFE) graft.

The stent design has a reduced number of net junctions, which allowed flexibility and radial stiffness, minimizing the risk of kinking, something that is important to take into account, according to the researchers, because of knee joint movements. A total of 20 stents were placed in the 15 ET patients.

The mean follow-up period was nearly 46 months for each group, according to the report published in the Journal of Vascular Surgery (2005;42:185-93).

For OR, reversed greater saphenous vein was the conduit of choice, according to the researchers, although in four patients (27%) a prosthetic bypass was performed using cross-linked PTFE when there was an unsuitable saphenous vein.

The inflow artery varied: the common femoral artery (13%), the superficial femoral (47%), and the above-knee popliteal artery (40%).

Kaplan-Meier analysis showed that the 1-year primary patency rate was 100% at 1 year for the OR group, compared with 87% at 1 year for the ET group. The differences were not statistically significant. The mean operation time was over twice as long for OR (155 min), compared with ET (75 min), and nearly twice as long for hospital stay (OR, 7.7 days, ET 4.3 days), both statistically significant differences.

The researchers observed no signs of endoleak in the ET group during the follow-up period, and they attributed this to their approach that included the embolization of any significant collateral vessels that originated from the aneurysmal sac.

They concluded that, given the limitations of their study and the need for a trial with a larger number of patients and longer follow-up, "PAA treatment can safely be performed using either OR or ET.

"The choice of the ET has several advantages, such as quicker recovery and shorter hospital stay, and should be preferentially used in patients with a high surgical risk."

It was PAA that sidelined Vice President Cheney recently.

"With his history of serious heart problems, Cheney was felt to be at risk for major surgery," and for this reason he was treated using an endovascular graft, a less invasive technique, which could be performed under local anesthetic and would result in less hospital time, according to the American Vascular Association.

VICE PRESIDENT CHENEY, WITH HIS HISTORY OF SERIOUS HEART PROBLEMS, WAS RECENTLY TREATED FOR HIS PAA USING AN ENDOVASCULAR GRAFT.