63 - Communication libre
16 mai 2019, 13:45 - 15:15, Sopra Grande, 4ème étage
Mid-term results comparing endovascular asymptomatic popliteal aneurysm repair versus open bypass surgery
K. Pavotbawan1, M. Furrer1, U. Derungs2, S. Hofer1, Presenter: K. Pavotbawan1 (1Chur, 2Glarus)
According to the data in the literature endovascular treatment of popliteal aneurysm seems to be associated with lesser patency rates compared to bypass surgery. The aim of this study was to assess the outcome in our cohort comparing both treatment strategies.
Between January 2014 and December 2017, we treated 27 popliteal aneurysms. Symptomatic patients were excluded. After evaluating the patients risk factors, we performed either femoral-popliteal bypass using autologous reversed vein under general anesthesia or endovascular repair using VIABAHN stentgraft (W. L. Gore & Associates, Inc.) under local anesthesia. Patients were assessed 3 months and 1 year after surgery. Early results and follow up data were analyzed regarding surgery time, complication, length of stay and patency rate.
48% of the patients underwent endovascular repair (ER) and 52% were treated by open surgery (OS). Mean age was 77.6 (ER) vs. 66.5 (OS). The preoperative ASA score was significantly higher in the ER group (2.92 vs. 2.50, p <0.05). Three anastomotic aneurysms after previous bypass surgery were treated endovascular. Surgery time (65min vs. 180min, p <0.05) and length of stay (5.15d vs. 8.42d, p =0.079) was shorter in the ER group. Postoperative complications were two hemorrhages, one in each group. Primary assisted patency was 84% (ER) versus 93% (OS) after 3 months and 84% (ER) versus 86% (OS) after 12 months. The secondary patency rate was lower in the ER group, after 3 months 85% (ER) versus 93% (OS) and 1 year 71% (ER) versus 93% (OS).
Reintervention and graft thrombosis were more likely after endovascular repair. Therefore, open surgery is the preferable strategy in younger patients. In patients at risk, i.e. with high ASA score and with previous bypass surgery, endovascular popliteal aneurysm repair seems to be a good therapeutic alternative.