Comparison of Posterior and Medial Approaches in Popliteal Artery Aneurysm Surgery

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

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