Endovascular treatment of chronic occluded popliteal artery aneurysm: early and mid-term outcomes

BACKGROUND Critical limb ischemia (CLI) may be the consequence of chronic occluded popliteal artery aneurysm (PAA). Open repair (OR) offers better 5-year results than endovascular treatment, but in patients with severe comorbidities or unfit to OR, endovascular repair (ER) could represent a valid treatment option. The purpose of this retrospective study was to review our experience of endovascular popliteal aneurism repair (EVPAR) in patients with chronic occluded PAA. METHODS The endpoints assessed were: 1- and 3-year primary and secondary patency rates, technical success, 30-day major adverse events, major amputation free-survival, re-intervention and survival rates. RESULTS From May 2011 to April 2015, 25 patients (23 male), mean age of 74.4 years, underwent an EVPAR. No perioperative death and vascular access complications were recorded. Device technical success rate was 100%. The 30-day major adverse events rate was 4%: one stent graft occlusion with distal embolization was recorded. The 1- and 3-year primary and secondary patency rate were 79% and 85.8%, and 73.3% and 79.7%, respectively. At 3-year follow-up, the freedom from major amputation and survival rates were 100% and 96%. Stent-graft coverage length >20 cm (P=0.006), more than 2 stents used (P=0.005), and poor distal runoff (P=0.01) were negative predictors for patency. CONCLUSIONS The results of this retrospective study suggest that EVPAR seems a safe and efficacious treatment option in selected patients. Despite encouraging results, further research will be needed to assess long-terms results and to define the best treatment option for patient with chronic occluded PAA.