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 PS132. Factors Affecting Outcome After Endovascular Repair (EVPAR) of Popliteal Artery Aneurysms (PAAs)

Ying Huang, Peter Gloviczki, Audra A. Duncan, Gustavo S. Oderich, Manju Kalra, Mark D. Fleming, Thomas C. Bower
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.

OBJECTIVES: To analyze factors affecting outcome after EVPAR.

METHODS: Clinical data of consecutive PAA patients treated with EVPAR (2000-2012) were reviewed. Primary endpoints were major adverse events: mortality, thrombosis, amputation, complications, reinterventions.

RESULTS: EVPAR was performed in 46 limbs, 38 patients: elective: 33 (72%), emergent: 13 (28%). One aneurysm ruptured, 12 caused acute ischemia (12 underwent thrombolysis+ EVPAR). Mean of 2 ViabahnĀ® stent-grafts (range 1-4) were used. Sixteen procedures (35%) were performed percutaneously, 30 through femoral cutdown. Technical success was 98%. Thirty-day mortality was 4.4%, all after emergencies (15.4%, 2/13). Thirty-day primary and secondary patencies were 100% for elective, 75% and 84%, respectively, for emergencies. Two major amputations (15.4%) were done after emergent EVPAR. Early complications were more frequent after emergencies (77% vs. 12%, p< 0.0001). Intracranial hemorrhage occurred in one patient (2.2%). Mean follow-up was 2.2 years (30 days-8.6 years). At 2 years, primary patencies were 70% and 64% (p=0.44), secondary patencies 80% and 84%, (p=0.79); no limb was lost in elective cases, limb salvage was 84% for emergencies (p=0.02); reinterventions were similar (19% and 30%); major adverse events occurred after 20 procedures (44%) (elective: 38%, emergent: 64%, p=0.01). There were 5 conversions (elective: 4, emergent: 1). Factors affecting adverse events included emergent EVPAR and percutaneous placement.

CONCLUSIONS: PAA with acute presentation continues to have elevated mortality (16%) and limb loss (16%). Although elective EVPAR has excellent early results, 2-year patency of 80% remains a concern.

AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; A. A. Duncan: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; Y. Huang: Nothing to disclose; M. Kalra: Nothing to disclose; G. S. Oderich: Gore, Consulting fees or other remuneration (payment); Cook, Consulting fees or other remuneration (payment).
Posted April 2013

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