Problems with open approach History of popliteal aneurysm repair - PowerPoint PPT Presentation

4/3/2014 History of popliteal aneurysm repair Outcomes for Endovascular Treatment of Popliteal Aneurysms 2nd century AD, Antyllus, the ‘Father of Aneurysm are Similar to Open Repair Surgery’ performed the first recorded aneurysm repair with proximal and DISCLOSURES distal arterial ligation and Grants: NIA, NHLBI, Aastrom Biosciences evacuation of the aneurysmal sac Other support: VA Nebraska-Western Iowa Health Care System 1785, John Hunter performed arterial Techniques to ligation at the adductor induce thrombosis canal for treatment of a using compression popliteal artery aneurysm Problems with open approach History of popliteal aneurysm repair 1888, Rudolph Matas first performed endoaneurysmoraphy for a traumatic brachial artery aneurysm. Proximal and distal ligation with oversewing of patent collaterals ACS Surgery -Continued flow into aneurysm sac from collateral vessels( type 2 endoleak) -Continued expansion leading to mass effect and possible rupture 1969, Sterling Edwards described the -Large wound technique of exclusion and saphenous -Sacrifice of Saphenous Vein vein bypass -Need for long-term Vein Surveillance to Prevent Thrombosis 1

4/3/2014 Comparison of Open and Endovascular Repair Hybrid Repair 70 yo patient s/p AF2 repair presents with: -anastomotic pseudoaneurysm of the R limb of the AF2 to the RCFA and -R popliteal aneurysm The latest three reviews of the literature: 1.Lovegrove RE, Javid M, Magee TR, Galland RB. Endovascular and open approaches to non-thrombosed popliteal aneurysm repair: a meta-analysis. Eur J Vasc Endovasc Surg. 2008 Jul;36(1):96-100 2. Cina CS. Endovascular repair of popliteal aneurysms. J Vasc Surg. 2010 Apr;51(4):1056-60. 3. Tsilimparis N, Dayama A, Ricotta JJ 2nd. Open and endovascular repair of popliteal artery aneurysms: tabular review of the literature. Ann Vasc Surg. 2013 Feb;27(2):259-65. Open repair Endovascular repair (8 x 15 Viabahn) Open repair of the anastomotic pseudoaneurysm of the R limb of prior AF2 to the RCFA (14-7 knitted prosthetic graft) 2

4/3/2014 Large Femoropopliteal Aneurysm Large Femoropopliteal Aneurysm RSFA-TP trunk bypass RSFA-TP trunk bypass Demographics and Clinical Presentation Demographics and Clinical Presentation Clinical Presentation Average Asymptomatic 41% Symptomatic 59% Acute limb ischemia 25% Rupture 3% Claudication 31% Tsilimparis N, et al. Ann Vasc Surg. 2013 Tsilimparis N, et al. Ann Vasc Surg. 2013 3

4/3/2014 Anatomic Features Type of Treatment Tsilimparis N, et al. Ann Vasc Surg. 2013 Tsilimparis N, et al. Ann Vasc Surg. 2013 Early outcomes (<30 days) Late outcomes (>30 days) Tsilimparis N, et al. Ann Vasc Surg. 2013 Tsilimparis N, et al. Ann Vasc Surg. 2013 4

4/3/2014 Outcomes Three year patency Lovegrove RE, et al. Eur J Vasc Endovasc Surg 2008 Cina CS, J Vasc Surg. 2010 Summary Endovascular repair of popliteal artery aneurysms offers similar short and medium-term benefits as an open repair. However, short-term graft thrombosis and reintervention rates are significantly greater with endovascular repair. The choice between open repair, and endovascular repair, needs to be balanced on an individual basis based on anatomical and patient- related characteristics. Further studies are necessary to define indications, anatomical and prosthetic graft limitations, and the exact role of postoperative anticoagulation therapy. 5