Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: a Vascunet Report

• Published in: European Journal of Vascular and Endovascular Surgery
• Main Authors: Grip, O, Mani, K, Altreuther, M, Bastos Gonçalves, F, Beiles, B, Cassar, K, Davidovic, L, Eldrup, N, Lattmann, T, Laxdal, E, Menyhei, G, Setacci, C, Settembre, N, Thomson, I, Venermo, M, Björck, M
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2020
• Subjects: HSM CIR VASC; Humans; Aged; Male; Female; Middle Aged; Acute Disease / epidemiology; Acute Disease / therapy; Amputation; Surgical / statistics & numerical data; Aneurysm / complications; Aneurysm / epidemiology; Aneurysm / pathology; Aneurysm / surgery*; Australia / epidemiology; Brazil / epidemiology; Elective Surgical Procedures / adverse effects; Elective Surgical Procedures / methods; Elective Surgical Procedures / statistics & numerical data; Endovascular Procedures / adverse effects; Endovascular Procedures / methods; Europe / epidemiology; Incidence; Global Burden of Disease; Ischemia / epidemiology; Ischemia / etiology; Ischemia / surgery*; Limb Salvage / adverse effects; Limb Salvage / methods; Limb Salvage / statistics & numerical data*; New Zealand / epidemiology; Popliteal Artery / pathology*; Popliteal Artery / surgery; Prospective Studies; Risk Factors; Registries / statistics & numerical data; Retrospective Studies; Thrombosis / epidemiology; Thrombosis / etiology; Thrombosis / surgery*; Treatment Outcome; Vascular Grafting / adverse effects; Vascular Grafting / methods; Vascular Grafting / statistics & numerical data; Vascular Patency; New Zealand; Norway; Paa; Iceland
• Online Access: http://hdl.handle.net/10400.17/4794; https://doi.org/10.1016/j.ejvs.2020.07.005

Objective: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. Methods: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). Results: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. Conclusion: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic ...