Comparison of Posterior and Medial Approaches in Popliteal Artery Aneurysm Surgery

Year 2021, , 300 - 308, 31.08.2021

Ufuk Sayar , Muhammed Onur Hanedan , Mehmet Ali Yürük Aşkın Kılıç Ali Kemal Arslan İlker Mataracı

https://doi.org/10.24938/kutfd.876194

Abstract

Objective: We compared the early and late results of our surgical approaches in popliteal artery aneurysms that can cause symptoms such as thrombosis, distal embolization and rupture or are asymptomatic.

Material and Methods: Thirty-one aneurysms in 30 patients who underwent surgery for popliteal artery aneurysm in our clinic between March 2009 and March 2020 were included in the study. Patients with a popliteal aneurysm diameter of 2 cm or greater were operated. The patients were followed for graft patency and mortality.

Results: The mean age of the patients was 69.66±12.18 years and most of them were male (n=26, 83.9%). The mean aneurysm diameter was 47.53±19.59 mm. There was no difference between the two approaches in terms of early mortality. When survival was investigated, one and five years of survival were 88%, 58%, and 70%, 63% in the posterior and medial approaches, respectively. The mean survival time was 72.39±11.66 months in the posterior approach and 75.83±16.07 months in the medial approach. There was no difference in long-term survival between the two groups (p=0.95). When comparing long-term graft patency, one, five and nine-year patency rates for the posterior and medial approaches were 75%, 75%, 54%, and 68%, 58%, 29%, respectively. There was no difference between the two groups (p=0.46). Saphenous vein grafts were observed to remain patent longer than prosthetic materials (p=0.047).

Conclusion: Although there is no difference between medial and posterior approaches in terms of mortality and graft patency in popliteal artery aneurysm surgery, saphenous vein graft patency is superior to prosthetic grafts regardless of the surgical approach.

Keywords

popliteal aneurysm, posterior approach, medial approach

POPLİTEAL ARTER ANEVRİZMA CERRAHİSİNDE POSTERİOR VE MEDİAL YAKLAŞIM SONUÇLARININ KARŞILAŞTIRILMASI

Abstract

Amaç: Tromboz, distal embolizasyon ve rüptür gibi semptomlara yol açabilen ya da asemptomatik olan popliteal arter anevrizmalarındaki cerrahi yaklaşımlarımızın erken ve geç dönem sonuçlarını karşılaştırdık.

Gereç ve Yöntemler: Kliniğimizde Mart 2009 - Mart 2020 tarihleri arasında popliteal arter anevrizması nedeniyle cerrahi uygulanan 30 hastadaki 31 anevrizma çalışmaya dahil edildi. Popliteal anevrizma çapı 2 cm ve üzeri olan hastalar operasyona alındı. Hastalar greft açıklığı ve mortalite açısından takip edildi.

Bulgular: Yaş ortalaması 69.66±12.18 olan hastaların %83.9 (n=26)’u erkek idi. Ortalama anevrizma çapı 47.53±19.59 mm olarak saptandı. Erken mortalite açısından iki yaklaşım arasında fark bulunamadı. Sağ kalım incelendiğinde ise bir ve beş yıllık sağ kalım posterior ve medial yaklaşımda sırasıyla %88, %58 ve %70, %63 idi. Ortalama sağ kalım süresi posterior yaklaşımda 72.39±11.66 ay iken medial yaklaşımda 75.83±16.07 ay idi. Her iki grup arasında uzun dönem sağ kalım bakımından fark yoktu (p=0.95). Uzun dönem greft açıklığı karşılaştırıldığında posterior ve medial yaklaşımlar için bir, beş ve dokuz yıllık açıklık oranları sırasıyla %75, %75, %54 ve %68, %58, %29 idi. İki grup arasında fark yoktu (p=0.46). Safen ven greftlerinin prostetik materyale göre daha uzun açık kaldığı gözlemlendi (p=0.047).

Sonuç: Popliteal arter anevrizma cerrahisinde medial ve posterior yaklaşımlar arasında mortalite ve greft açıklığı bakımından fark olmamakla birlikte cerrahi yaklaşımdan bağımsız olarak safen ven greft açıklığı prostetik greftlere üstündür.

Keywords

popliteal anevrizma, posterior yaklaşım, medial yaklaşım

References

• 1. Dawson I, Sie RB, Van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg. 1997;84:293-99.
• 2. Fatima J, Gloviczki P. Popliteal artery aneurysms. In: Ascher E, ed. Haimovici’s Vascular Surgery. 6th ed. West Sus. Whiley-Blackwell, 2012;801-10.
• 3. Huang Y, Gloviczki P, Noel AA, Sullivan TM, Kalra M, Gullerud RE et al. Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: Is exclusion with saphenous vein bypass still the gold standart? J Vasc Surg. 2007;45:706-15.
• 4. Beseth BD, Moore WS. The posterior approach for repair of popliteal artery aneurysms. J Vasc Surg. 2006;43:940-5.
• 5. Roggo A, Brunner U, Ottinger LW, Largiader F. The continuing challenge of aneurysms of the popliteal artery. Surg Gynecol Obstet. 1993;177(6):565-72.
• 6. Lowell RC, Gloviczki P, Hallett J, Naessens JM, Maus TP, Cherry KJ et al. Popliteal artery aneurysms: the risk of nonoperative management. Ann Vasc Surg. 1994;8(1):14-23.
• 7. Pittathankal AA, Dattani R, Magee TR, Galland RB. Expansion rates of asymptomatic popliteal artery aneurysms. Eur J Endovasc Surg. 2004;27(4):382-4.
• 8. Cross JE, Galland RB, Hingorani A, Ascher E. Non-operative versus surgical management of small (less than 3 cm), asymptamatic popliteal aneurysms. J Vasc Surg. 2011;53(4):1145-8.
• 9. Ravn H, Wanhainen A, Björck M. Swedish Vascular Registry (Swedvasc). Surgical technique and long-term results after popliteal artery aneurysm repair: results from 717 legs. J Vasc Surg. 2007;46(2):236-43.
• 10. Box B, Adamson M, Magee TR, Galland RB. Outcome following bypass and proximal and distal ligation of popliteal aneurysms. Br J Surg. 2007;94(2):179-82.
• 11. Mazzaccaro D, Carmo M, Dallatana R, Settembrini A, Barbetta I, Tassinari L et al. Comparasion of posterior and medial approaches for popliteal artery aneurysms. J Vasc Surg. 2015;62(6):1512-20.
• 12. Phair A, Hajibandeh S, Hajibandeh S, Kelleher D, Ibrahim R, A Antoniou G. Meta-analysis of posterior versus medial approach for popliteal artery aneurysm repair. J Vasc Surg. 2016;64(4):1141-50.
• 13. Pulli R, Dorigo W, Troisi N, Innocenti A, Pratesi G, Azas L et al. Surgical management of popliteal artery aneurysms: Which factors affect outcomes? J Vasc Surg. 2006;43(3):481-7.
• 14. Huang Y, Gloviczki P. Popliteal artery aneurysms: rationale, technique and results of endovascular treatment. Perspect Vasc Surg Endovasc Ther. 2008;20(2):201-13.
• 15. Leake AE, Segal MA, Chaer RA, Eslami MH, Al-Khoury G, Makaroun MS et al. Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg. 2017;65(1):246-56.