Treatment of Popliteal Artery Aneurysm Disease

36 Pages·2016·3.36 MB·English

Treatment of Popliteal Artery Aneurysm Disease
Luke Marone MD,FACS
Professor of Surgery & Radiology
Chief of Vascular and Endovascular Surgery
Co-Director Heart and Vascular Institute
WVU Medicine
Disclosures

None

A More Relevant Disclosure
• 70% of my current practice has become endovascular over
the last decade
Popliteal Aneurysm
 70% of all peripheral aneurysms
 Incidence only 0.1%
 Repair indicated at >2 cm
 Clinical sequelae include
Embolism
1.
Thrombosis
2.
Compressive symptoms
3.
Rupture (rare)
4.

 Standard repair: surgical bypass
Who Develops A Popliteal Aneurysm?
• Tabular review of the existing literature
through 2012
• 4247 patients were identified
• 5459 limbs were treated
• 96% males
• Mean age 65

Tsilimparis et al. Ann Vasc Surg 2013;27:259-265
Comorbid Conditions Common to
Popliteal Aneurysm
Tsilimparis et al. Ann Vasc Surg 2013;27:259-265
How do these patients present?
• The majority of patients are asymptomatic
• 30% present with symptoms of claudication and moderate
chronic ischemia
• 17% present with acute limb ischemia requiring emergent
repair

• Majority have 2 to 3 vessel run off at the time of intervention

The majority present for elective repair!
Huang et al. J Vasc Surg 2014; on line 1-8.
Ravn et al. J Vasc Surg 2007;46:236-43.
The Endovascular Era

An evolution toward endovascular (minimally invasive)
intervention has occurred

Why has this paradigm shift occurred?
What is the “Gold Standard” for comparison?
What outcomes are important for comparison?
I am going to present an argument to
support this shift
Why has this shift occurred?
Po tential benefits of endovasc ular repair

• Lower rate of wound
complications
• Decreased functional
disability
• Reduced patient
discomfort
• Decreased need for
general anesthesia
• Shorter hospital length
of stay
What is the “Gold Standard” repair?
• Medial approach (exclusion
and bypass)
• GSV, prosthetic, arm vein
• Tunneled subcutaneous or
anatomic
• Target variability (BK pop, TP
trunk or tibial)

• Posterior approach
• GSV,SSV or prosthetic

There are no randomized trials
comparing these diverse
procedures