Daniela Mazzaccaro1, Michele Carmo1, Giovanni Grava1, Alberto M. Settembrini1, Raffaello Dallatana1, Iacopo Barbetta1, Piergiorgio Settembrini2
1Division of Vascular Surgery S.Carlo Borromeo Hospital, Milan, Italy; 2Università degli Studi di Milano, Milan, Italy.
OBJECTIVES: Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years’ period.
METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis.
RESULTS: A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years).
Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9±1 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%.
One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months).
Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%±8,7% and 96.4%±3.5% respectively for PA, and 67.4%±10,4% and 81.3%±8,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%±6.4% at 5 and 10 years respectively for PA and 91.5%±5.6% at both time points for MA (p=0.3).
CONCLUSIONS: PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA.
AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose.
Posted April 2012