Comparison of posterior and medial approaches for popliteal artery aneurysms

Daniela Mazzaccaro, Michele Carmo, Raffaello Dallatana, Alberto M. Settembrini, Iacopo Barbetta, Luca Tassinari, Sergio Roveri, Piergiorgio G. Settembrini

Research output: Contribution to journalArticle

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Abstract

Background Long-term results of the posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We reviewed our experience during a 13-year period in patients with popliteal artery aneurysms, comparing those treated through a PA with those operated on through a standard medial approach (MA). Methods Clinical data of all patients treated between February 1998 and October 2011 were retrospectively reviewed and outcomes analyzed. The Kaplan-Meier method was used to estimate survival, and χ2, Wilcoxon, and log-rank tests were used for analysis. Results A total of 77 aneurysms were treated in 65 patients (64 men). Mean age was 68 years (range, 48-96 years). Thirty-six aneurysms were asymptomatic (47%). Mean sac diameter was 2.8 ± 1 cm. A PA was used in 43 PAAs (55%) and an MA in 34. The PA and MA patients differed significantly in age (median being older), smoking history (more frequent in PA), and renal insufficiency and cerebrovascular disease (higher for MA). In 42 cases the aneurysm was symptomatic (54.5%) for chronic limb ischemia, with intermittent claudication in 18 patients, acute ischemia in 17, blue toe syndrome in 3, compression on adjacent structures in 3, and rupture with severe acute pain in 1. All PA repairs consisted of aneurysmectomy with an interposition graft with end-to-end anastomoses; among MA repairs, 22 interposition grafts and 12 bypasses were performed. A polytetrafluoroethylene graft was used in 54 cases. Five patients had an early thrombosis (two PA and three MA). No perioperative deaths occurred. Two patients sustained a permanent (PA) and a temporary (MA) peroneal nerve lesion. There were no early amputations. The median in-hospital stay was longer for MA (10 days) than for PA (7 days; P =.02). Median follow-up was 58.8 months (range, 5 days-166 months). Nine patients died during follow-up of unrelated causes. The 5-year primary and secondary patency rates were 59.6% ± 8.6% and 96.5% ± 3.4%, respectively, for PA, and 65.1% ± 11.1% and 79.4% ± 9.7%, respectively, for MA (P =.53 for primary patency rate and P =.22 for secondary patency rate). Limb salvage was 100% at 5 years and 93.3% ± 6.4% at 10 years for PA and 91.1% ± 6.3% at both time points for MA (P =.28). Conclusions PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.

Original languageEnglish
Pages (from-to)1512-1520
Number of pages9
JournalJournal of Vascular Surgery
Volume62
Issue number6
DOIs
Publication statusPublished - Dec 1 2015

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Popliteal Artery
Aneurysm
Limb Salvage
Transplants
Blue Toe Syndrome
Length of Stay
Ischemia
Cerebrovascular Disorders
Intermittent Claudication
Peroneal Nerve
Polytetrafluoroethylene
Acute Pain
Nonparametric Statistics
Amputation
Renal Insufficiency
Rupture
Thrombosis
Extremities
Smoking
History

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mazzaccaro, D., Carmo, M., Dallatana, R., Settembrini, A. M., Barbetta, I., Tassinari, L., ... Settembrini, P. G. (2015). Comparison of posterior and medial approaches for popliteal artery aneurysms. Journal of Vascular Surgery, 62(6), 1512-1520. https://doi.org/10.1016/j.jvs.2015.06.227

Comparison of posterior and medial approaches for popliteal artery aneurysms. / Mazzaccaro, Daniela; Carmo, Michele; Dallatana, Raffaello; Settembrini, Alberto M.; Barbetta, Iacopo; Tassinari, Luca; Roveri, Sergio; Settembrini, Piergiorgio G.

In: Journal of Vascular Surgery, Vol. 62, No. 6, 01.12.2015, p. 1512-1520.

Research output: Contribution to journalArticle

Mazzaccaro, D, Carmo, M, Dallatana, R, Settembrini, AM, Barbetta, I, Tassinari, L, Roveri, S & Settembrini, PG 2015, 'Comparison of posterior and medial approaches for popliteal artery aneurysms', Journal of Vascular Surgery, vol. 62, no. 6, pp. 1512-1520. https://doi.org/10.1016/j.jvs.2015.06.227
Mazzaccaro, Daniela ; Carmo, Michele ; Dallatana, Raffaello ; Settembrini, Alberto M. ; Barbetta, Iacopo ; Tassinari, Luca ; Roveri, Sergio ; Settembrini, Piergiorgio G. / Comparison of posterior and medial approaches for popliteal artery aneurysms. In: Journal of Vascular Surgery. 2015 ; Vol. 62, No. 6. pp. 1512-1520.
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abstract = "Background Long-term results of the posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We reviewed our experience during a 13-year period in patients with popliteal artery aneurysms, comparing those treated through a PA with those operated on through a standard medial approach (MA). Methods Clinical data of all patients treated between February 1998 and October 2011 were retrospectively reviewed and outcomes analyzed. The Kaplan-Meier method was used to estimate survival, and χ2, Wilcoxon, and log-rank tests were used for analysis. Results A total of 77 aneurysms were treated in 65 patients (64 men). Mean age was 68 years (range, 48-96 years). Thirty-six aneurysms were asymptomatic (47{\%}). Mean sac diameter was 2.8 ± 1 cm. A PA was used in 43 PAAs (55{\%}) and an MA in 34. The PA and MA patients differed significantly in age (median being older), smoking history (more frequent in PA), and renal insufficiency and cerebrovascular disease (higher for MA). In 42 cases the aneurysm was symptomatic (54.5{\%}) for chronic limb ischemia, with intermittent claudication in 18 patients, acute ischemia in 17, blue toe syndrome in 3, compression on adjacent structures in 3, and rupture with severe acute pain in 1. All PA repairs consisted of aneurysmectomy with an interposition graft with end-to-end anastomoses; among MA repairs, 22 interposition grafts and 12 bypasses were performed. A polytetrafluoroethylene graft was used in 54 cases. Five patients had an early thrombosis (two PA and three MA). No perioperative deaths occurred. Two patients sustained a permanent (PA) and a temporary (MA) peroneal nerve lesion. There were no early amputations. The median in-hospital stay was longer for MA (10 days) than for PA (7 days; P =.02). Median follow-up was 58.8 months (range, 5 days-166 months). Nine patients died during follow-up of unrelated causes. The 5-year primary and secondary patency rates were 59.6{\%} ± 8.6{\%} and 96.5{\%} ± 3.4{\%}, respectively, for PA, and 65.1{\%} ± 11.1{\%} and 79.4{\%} ± 9.7{\%}, respectively, for MA (P =.53 for primary patency rate and P =.22 for secondary patency rate). Limb salvage was 100{\%} at 5 years and 93.3{\%} ± 6.4{\%} at 10 years for PA and 91.1{\%} ± 6.3{\%} at both time points for MA (P =.28). Conclusions PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.",
author = "Daniela Mazzaccaro and Michele Carmo and Raffaello Dallatana and Settembrini, {Alberto M.} and Iacopo Barbetta and Luca Tassinari and Sergio Roveri and Settembrini, {Piergiorgio G.}",
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T1 - Comparison of posterior and medial approaches for popliteal artery aneurysms

AU - Mazzaccaro, Daniela

AU - Carmo, Michele

AU - Dallatana, Raffaello

AU - Settembrini, Alberto M.

AU - Barbetta, Iacopo

AU - Tassinari, Luca

AU - Roveri, Sergio

AU - Settembrini, Piergiorgio G.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Long-term results of the posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We reviewed our experience during a 13-year period in patients with popliteal artery aneurysms, comparing those treated through a PA with those operated on through a standard medial approach (MA). Methods Clinical data of all patients treated between February 1998 and October 2011 were retrospectively reviewed and outcomes analyzed. The Kaplan-Meier method was used to estimate survival, and χ2, Wilcoxon, and log-rank tests were used for analysis. Results A total of 77 aneurysms were treated in 65 patients (64 men). Mean age was 68 years (range, 48-96 years). Thirty-six aneurysms were asymptomatic (47%). Mean sac diameter was 2.8 ± 1 cm. A PA was used in 43 PAAs (55%) and an MA in 34. The PA and MA patients differed significantly in age (median being older), smoking history (more frequent in PA), and renal insufficiency and cerebrovascular disease (higher for MA). In 42 cases the aneurysm was symptomatic (54.5%) for chronic limb ischemia, with intermittent claudication in 18 patients, acute ischemia in 17, blue toe syndrome in 3, compression on adjacent structures in 3, and rupture with severe acute pain in 1. All PA repairs consisted of aneurysmectomy with an interposition graft with end-to-end anastomoses; among MA repairs, 22 interposition grafts and 12 bypasses were performed. A polytetrafluoroethylene graft was used in 54 cases. Five patients had an early thrombosis (two PA and three MA). No perioperative deaths occurred. Two patients sustained a permanent (PA) and a temporary (MA) peroneal nerve lesion. There were no early amputations. The median in-hospital stay was longer for MA (10 days) than for PA (7 days; P =.02). Median follow-up was 58.8 months (range, 5 days-166 months). Nine patients died during follow-up of unrelated causes. The 5-year primary and secondary patency rates were 59.6% ± 8.6% and 96.5% ± 3.4%, respectively, for PA, and 65.1% ± 11.1% and 79.4% ± 9.7%, respectively, for MA (P =.53 for primary patency rate and P =.22 for secondary patency rate). Limb salvage was 100% at 5 years and 93.3% ± 6.4% at 10 years for PA and 91.1% ± 6.3% at both time points for MA (P =.28). Conclusions PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.

AB - Background Long-term results of the posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We reviewed our experience during a 13-year period in patients with popliteal artery aneurysms, comparing those treated through a PA with those operated on through a standard medial approach (MA). Methods Clinical data of all patients treated between February 1998 and October 2011 were retrospectively reviewed and outcomes analyzed. The Kaplan-Meier method was used to estimate survival, and χ2, Wilcoxon, and log-rank tests were used for analysis. Results A total of 77 aneurysms were treated in 65 patients (64 men). Mean age was 68 years (range, 48-96 years). Thirty-six aneurysms were asymptomatic (47%). Mean sac diameter was 2.8 ± 1 cm. A PA was used in 43 PAAs (55%) and an MA in 34. The PA and MA patients differed significantly in age (median being older), smoking history (more frequent in PA), and renal insufficiency and cerebrovascular disease (higher for MA). In 42 cases the aneurysm was symptomatic (54.5%) for chronic limb ischemia, with intermittent claudication in 18 patients, acute ischemia in 17, blue toe syndrome in 3, compression on adjacent structures in 3, and rupture with severe acute pain in 1. All PA repairs consisted of aneurysmectomy with an interposition graft with end-to-end anastomoses; among MA repairs, 22 interposition grafts and 12 bypasses were performed. A polytetrafluoroethylene graft was used in 54 cases. Five patients had an early thrombosis (two PA and three MA). No perioperative deaths occurred. Two patients sustained a permanent (PA) and a temporary (MA) peroneal nerve lesion. There were no early amputations. The median in-hospital stay was longer for MA (10 days) than for PA (7 days; P =.02). Median follow-up was 58.8 months (range, 5 days-166 months). Nine patients died during follow-up of unrelated causes. The 5-year primary and secondary patency rates were 59.6% ± 8.6% and 96.5% ± 3.4%, respectively, for PA, and 65.1% ± 11.1% and 79.4% ± 9.7%, respectively, for MA (P =.53 for primary patency rate and P =.22 for secondary patency rate). Limb salvage was 100% at 5 years and 93.3% ± 6.4% at 10 years for PA and 91.1% ± 6.3% at both time points for MA (P =.28). Conclusions PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.

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