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

• Published in: European Journal of Vascular and Endovascular Surgery
• Main Authors: Grip, Olivia, Mani, Kevin, Altreuther, Martin, Goncalves, Frederico Bastos, Beiles, Barry, Cassar, Kevin, Davidovic, Lazar, Eldrup, Nikolaj, Lattmann, Thomas, Laxdal, Elin, Menyhei, Gabor, Setacci, Carlo, Settembre, Nicla, Thomson, Ian, Venermo, Maarit, Björck, Martin
• Format: Article in Journal/Newspaper
• Language: English
• Published: Uppsala universitet, Kärlkirurgi 2020
• Subjects: Aneurysm - popliteal artery; Endovascular; Epidemiology; Open surgery; Registry; Surgery; Kirurgi; New Zealand; Norway; Paa; Iceland
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-426371; 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 ...