James R. Ballard, Gregory J. Landry
Vascular Surgery, Oregon Health & Science University, Portland, OR.
OBJECTIVES: Endovascular popliteal aneurysm repair (EPAR) is an accepted option to open surgical repair in select patients. Anatomic restrictions limit suitability of EPAR, and the percentage of patients amenable to EPAR is not well documented. In this study, a cohort of patients undergoing surgical popliteal artery aneurysm repair was reviewed to determine EPAR suitability.
METHODS: A retrospective review of all patients who underwent popliteal aneurysm repair from 1995 to 2011 was performed to determine the number of patients appropriate for EPAR. Exclusion criteria for EPAR included single vessel runoff, stent placement which would result in single vessel runoff, occlusion of SFA, thrombosis or rupture of the popliteal artery aneurysm, aneurysm extending to within 2 cm of the tibioperoneal trunk or proximal extension to the mid SFA.
RESULTS: Sixty-one patients (95% male) with 111 popliteal artery aneurysms were identified. Fifty-three percent of patients were symptomatic at presentation. Seventy-six aneurysms were repaired during the study period. Of the 111 aneurysms, 69 had imaging sufficient to evaluate for EPAR. Runoff was a single vessel in (17%), two vessels in (30%), three vessels in (30%), and the popliteal artery was occluded in (19%). In 19 of the 69 aneurysms the imaging was determined inadequate to determine eligibility for EPAR. Based on imaging it was determined that 36% of aneurysms would have qualified for stent graft repair. Only 18% of symptomatic patients and 31% of asymptomatic patients were candidates for EPAR.
CONCLUSIONS: Anatomic restrictions make EPAR unsuitable in the majority of patients with popliteal aneurysms, particularly in symptomatic patients. Surgical repair remains the procedure of choice in the majority of patients with popliteal aneurysms.
AUTHOR DISCLOSURES: J. R. Ballard, Nothing to disclose; G. J. Landry, Nothing to disclose.
Posted April 2012