Stent-Graft Placement in Popliteal Artery Aneurysms: Midterm Results
- Volume 4 - Issue 4 - July/August 2007
- Posted on: 9/5/08
- 1 Comments
- 12619 reads
Reza Ghotbi, MD, Agamemnon Sotiriou, MD, Sylvia Schönhofer, MD, Dimitrios Zikos, MD,
Kerstin Schips, MD, Wolfgang Westermeier, MD
Decisive for the choice of the diameter is the peripheral vessel diameter; this is measured in CT scan. In case of a big difference between central and peripheral vessel diameter, we prefer to overlap two endografts outside the flexion zone, which is usually possible with the available endografts.
With improvement of endovascular technique and the development of a more flexible, tapered and heparinized device, the limitations of this technique will be solved.
There is a general consensus that symptomatic popliteal aneurysms should be repaired, irrespective of size. Several studies have shown that medical therapy has no effect on the enlargement of PAA, and ischemic complications cannot be prevented by watchful waiting.10
For acute limb ischemia resulting from a thrombosed popliteal aneurysm, thrombolysis, or even emergency surgery, are not safe options. The severity of outcomes includes a risk of major amputation of up to 50%.25,27,28 Moreover, there is a sharp contrast between the rates of complications with urgent rather than elective treatment.10
So, the question is not whether PAA should be treated:. “Popliteal aneurysm is safe to leave.”42 Asymptomatic PAA larger than 2 cm in diameter should be treated too, particularly if they contain significant mural thrombus.19–24
Because of the biomechanical particularity of the popliteal artery and rareness of PAA, it is the last holy bastion of conventional open vascular surgery. There is no doubt that open surgical exclusion has been standard therapy, with excellent long-term patency. We should, however, recognize that one of the main arguments against early elective operative therapy is the high morbidity rate of the excision procedure.
Endovascular popliteal aneurysm repair is technically feasible and safe, with less morbidity. A selected cohort of patients with limited lesions, suitable anatomy, and appropriate medical therapy (clopidogrel), achieved patency rates in 4-year follow up, similar to those who had open surgery.
In summary, endovascular treatment is an emerging technique with favorable results. Consequently, it should be considered on a par with open procedures.
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