Michele Piazza1, Mirko Menegolo1, Alessandra Ferrari1, Joseph J. Ricotta2, Franco Grego1, Michele Antonello1
1Vascular and Endovascular Surgery Clinic, Padova University, Italy; 2NorthSide Heart and Vascular Institute, Atlanta, GA.
OBJECTIVES: To evaluate long-term outcomes and sac volume (SV) shrinkage after endovascular popliteal artery aneurysm repair (EVPAR).
METHODS: A retrospective review of EVPAR cases performed between January 1999 and December 2012. SV shrinkage, long-term patency, limb salvage (LS) and survival (S) were evaluated with K-M estimates. Anatomical characteristics and clinical presentation were evaluated for their association with patency using multiple logistic regression.
RESULTS: Forty-six EVPAR procedures in 42 patients. Mean age was 68 years, 86% were male; mean SV 42±12cm3. Elective repair in 91% of cases, while 9% treated for rupture or thrombosis; 56% were asymptomatic, 35% had claudication and 9% rest pain. Technical success was 98%. At mean follow-up of 84 months (range 6-138 months) primary, assisted primary and secondary patency was 63%, 68% and 68%; LS was 96% and S 81%. Of the 13 limbs with stent graft failure, 7 required conversion, 2 underwent amputation, while 4 remained with mild claudication. Of those with graft occlusion, 61% (8 out of 13) of cases occurred within the first year of follow-up. The overall mean difference in aneurysm SV shrinkage at 7 years was significant (42±12cm3 vs. 21±8cm3; p=0.02). The association of covering a length >20cm and distal landing zone between 1 and 1.5cm from the takeoff of the anterior tibial artery (ATA) was a negative predictor for improved patency (OR,3.05;95% CI, 1.9 to 2.3; p=0.005).
CONCLUSIONS: EVPAR provides successful aneurysm exclusion with acceptable long-term patency, excellent LS and S. However, close surveillance is required, particularly within the first post-operative year. Patients requiring coverage >20cm and a distal landing zone between 1 and 1.5cm from the ATA may be at increased risk for failure.
AUTHOR DISCLOSURES: M. Antonello: Nothing to disclose; A. Ferrari: Nothing to disclose; F. Grego: Nothing to disclose; M. Menegolo: Nothing to disclose; M. Piazza: Nothing to disclose; J. J. Ricotta: Nothing to disclose.
Posted April 2013