Results of elective and emergency endovascular repairs of popliteal artery aneurysms

Magdiel Trinidad-Hernandez, Joseph J. Ricotta, Peter Gloviczki, Manju Kalra, Gustavo Oderich, Audra A. Duncan, Thomas C. Bower

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). Methods: This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. Results: EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P =.14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P =.56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P =.15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. Conclusions: These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.

Original languageEnglish (US)
Pages (from-to)1299-1305
Number of pages7
JournalJournal of Vascular Surgery
Volume57
Issue number5
DOIs
StatePublished - May 1 2013

Fingerprint

Popliteal Artery
Stents
Aneurysm
Emergencies
Endoleak
Transplants
Extremities
Limb Salvage
Reoperation
Thrombosis
Ruptured Aneurysm
Emergency Treatment
Survival
Intracranial Hemorrhages
Thigh
Angioplasty
Hematoma
Multicenter Studies
Heparin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Trinidad-Hernandez, M., Ricotta, J. J., Gloviczki, P., Kalra, M., Oderich, G., Duncan, A. A., & Bower, T. C. (2013). Results of elective and emergency endovascular repairs of popliteal artery aneurysms. Journal of Vascular Surgery, 57(5), 1299-1305. https://doi.org/10.1016/j.jvs.2012.10.112

Results of elective and emergency endovascular repairs of popliteal artery aneurysms. / Trinidad-Hernandez, Magdiel; Ricotta, Joseph J.; Gloviczki, Peter; Kalra, Manju; Oderich, Gustavo; Duncan, Audra A.; Bower, Thomas C.

In: Journal of Vascular Surgery, Vol. 57, No. 5, 01.05.2013, p. 1299-1305.

Research output: Contribution to journalArticle

Trinidad-Hernandez, M, Ricotta, JJ, Gloviczki, P, Kalra, M, Oderich, G, Duncan, AA & Bower, TC 2013, 'Results of elective and emergency endovascular repairs of popliteal artery aneurysms', Journal of Vascular Surgery, vol. 57, no. 5, pp. 1299-1305. https://doi.org/10.1016/j.jvs.2012.10.112
Trinidad-Hernandez, Magdiel ; Ricotta, Joseph J. ; Gloviczki, Peter ; Kalra, Manju ; Oderich, Gustavo ; Duncan, Audra A. ; Bower, Thomas C. / Results of elective and emergency endovascular repairs of popliteal artery aneurysms. In: Journal of Vascular Surgery. 2013 ; Vol. 57, No. 5. pp. 1299-1305.
@article{d17e4e1611744504aa1dd2ff0df967b1,
title = "Results of elective and emergency endovascular repairs of popliteal artery aneurysms",
abstract = "Objective: Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). Methods: This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. Results: EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61{\%}) and emergent in 12 (39{\%}). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32{\%}) were performed percutaneously and 21 by femoral cutdown. Technical success was 97{\%}. Overall 30-day mortality was 6.4{\%}, with 0{\%} in the elective group, and 16.7{\%} in the emergent group (P =.14). Early complications included graft thrombosis in two limbs (6.4{\%}) and hematoma in four (13{\%}), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2{\%}). The 30-day primary and secondary patencies were 93.6{\%} and 96.7{\%}, respectively, and were 100{\%} in the elective group and 83.3{\%} and 91.6{\%}, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86{\%} (95{\%} for elective, 69{\%} for emergent; P =.56), secondary patency at the same time was 91{\%} (elective, 100{\%}; emergent, 91{\%}). One-year limb salvage was 97{\%}. Two-year survival was 91{\%} for the elective group and 73{\%} for the emergent group (P =.15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2{\%}), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10{\%}) type II endoleaks were detected but none had aneurysm expansion. One (3.2{\%}) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5{\%}). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. Conclusions: These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.",
author = "Magdiel Trinidad-Hernandez and Ricotta, {Joseph J.} and Peter Gloviczki and Manju Kalra and Gustavo Oderich and Duncan, {Audra A.} and Bower, {Thomas C.}",
year = "2013",
month = "5",
day = "1",
doi = "10.1016/j.jvs.2012.10.112",
language = "English (US)",
volume = "57",
pages = "1299--1305",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Results of elective and emergency endovascular repairs of popliteal artery aneurysms

AU - Trinidad-Hernandez, Magdiel

AU - Ricotta, Joseph J.

AU - Gloviczki, Peter

AU - Kalra, Manju

AU - Oderich, Gustavo

AU - Duncan, Audra A.

AU - Bower, Thomas C.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Objective: Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). Methods: This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. Results: EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P =.14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P =.56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P =.15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. Conclusions: These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.

AB - Objective: Endovascular repair has emerged as a treatment option for popliteal artery aneurysms. Our goal was to analyze outcomes of elective and emergency endovascular popliteal artery aneurysm repair (EVPAR). Methods: This was a retrospective review of clinical data of patients treated with EVPAR at our institution between 2004 and 2010. Stent-related complications, patency, outcome limb salvage, and survival were evaluated and analyzed. Results: EVPAR was performed in 31 limbs of 25 patients (mean age, 81 years; range, 65-89 years). Repair was elective in 19 limbs (61%) and emergent in 12 (39%). One aneurysm ruptured and 11 presented with acute thrombosis. All 11 underwent thrombolysis before EVPAR. Patients were implanted with a mean of 2.1 Viabahn stent grafts (range, 1-4). Ten procedures (32%) were performed percutaneously and 21 by femoral cutdown. Technical success was 97%. Overall 30-day mortality was 6.4%, with 0% in the elective group, and 16.7% in the emergent group (P =.14). Early complications included graft thrombosis in two limbs (6.4%) and hematoma in four (13%), all after percutaneous repair. Myocardial infarction and thrombolysis-associated intracranial hemorrhage occurred in one patient each (3.2%). The 30-day primary and secondary patencies were 93.6% and 96.7%, respectively, and were 100% in the elective group and 83.3% and 91.6%, respectively, for the emergent group. Mean follow-up was 21.3 months (range, 1-75 months). Primary patency at 1 year was 86% (95% for elective, 69% for emergent; P =.56), secondary patency at the same time was 91% (elective, 100%; emergent, 91%). One-year limb salvage was 97%. Two-year survival was 91% for the elective group and 73% for the emergent group (P =.15). Five stent occlusions were encountered after 30 days, four in the elective group. Four underwent successful reintervention, two had bypass, and two had thrombolysis, followed by angioplasty. The fifth patient was asymptomatic and nonambulatory and remains under observation. Stent graft infolding occurred in one limb (3.2%), with no clinical sequelae. No stent migration or separation was observed. One stent fracture was noted in an asymptomatic patient. Three (10%) type II endoleaks were detected but none had aneurysm expansion. One (3.2%) type I endoleak was treated percutaneously with placement of an additional stent graft. Overall, major adverse events, including death, graft occlusion with or without reoperation, or reoperation for endoleak or stent infolding occurred after 11 procedures (35.5%). On univariate analysis, no factors predicted stent failure, including runoff, antiplatelet therapy, emergency repair, number of stents implanted, heparin bonding of the stent, or degree of stent oversizing. Conclusions: These results support elective EVPAR in anatomically suitable patients with increased risk for open repair; however, major adverse events after EVPAR, mainly after emergency repairs, are frequent. A prospective randomized multicenter study to justify EVPAR in the emergent setting is warranted.

UR - http://www.scopus.com/inward/record.url?scp=84876416255&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876416255&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2012.10.112

DO - 10.1016/j.jvs.2012.10.112

M3 - Article

C2 - 23375609

AN - SCOPUS:84876416255

VL - 57

SP - 1299

EP - 1305

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 5

ER -