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The Capital Region of Denmark - a part of Copenhagen University Hospital

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

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  • Olivia Grip
  • Kevin Mani
  • Martin Altreuther
  • Frederico Bastos Gonçalves
  • Barry Beiles
  • Kevin Cassar
  • Lazar Davidovic
  • Nikolaj Eldrup
  • Thomas Lattmann
  • Elin Laxdal
  • Gabor Menyhei
  • Carlo Setacci
  • Nicla Settembre
  • Ian Thomson
  • Maarit Venermo
  • Martin Björck
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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 grafts should be reconsidered based on these results.

Original languageEnglish
JournalEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Issue number5
Pages (from-to)721-729
Number of pages9
Publication statusPublished - Nov 2020

    Research areas

  • Acute Disease/epidemiology, Aged, Amputation/statistics & numerical data, Aneurysm/complications, Australia/epidemiology, Brazil/epidemiology, Elective Surgical Procedures/adverse effects, Endovascular Procedures/adverse effects, Europe/epidemiology, Female, Global Burden of Disease, Humans, Incidence, Ischemia/epidemiology, Limb Salvage/adverse effects, Male, Middle Aged, New Zealand/epidemiology, Popliteal Artery/pathology, Prospective Studies, Registries/statistics & numerical data, Retrospective Studies, Risk Factors, Thrombosis/epidemiology, Treatment Outcome, Vascular Grafting/adverse effects, Vascular Patency

ID: 62412515