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Comparison Open and Endovascular Popliteal Aneurysm Repairs in a Single Center Experience

Introduction

Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysms and is the second most frequent localization of arterial aneurysm, with an incidence of 7.4 of 100.000 people. Commonly accepted indications for write my essay in asymptomatic patient. The most commonly symptoms are acute thrombosis or embolism with limb ischemia, or pain and/or swelling associated with axtrinsic popliteal vein compression. This condition, if untreated, can lead to high rate of complications, include risk of limb loss and death.

The first description of surgical repair of a PAA was in 1795 by John Hunter, who succesfully legated a large aneurysm at the adductor canal. During the last five decades, open repair of PAAs (OPAR) has proved to be extremely durable with ecxellent long term patency (primary patency up to 76% at 5 years). For this reason open repair with PAA exclusion and bypass or direct endoaneurysmorrhaphy has been the gold standard management strategy. Marin et al. First described the use of covered stent as means of PAAA repair in 1994. Since this date, endovascular intervention has become an attractive altrnative to open repair cause offers many potential advantages, including the use of local anestesia, shorter hospital stay and decreased blood loss. It can also represent alternative therapy in patients with relevant comorbidities and choice in case of non ideal indication for open surgery as in case of proximal involvement to the superficial femoral artery Although early reports yelded modest results with high thrombotic complications.

The aim of this retrospectively study was to compare perioperative (<30 days) and mid-term (36 months) results of open and endovascular repair on both symptomatic and asymptomatic patients, in our write my essay for me. The outcomes of the study was primary patency at 6 months, at 1 year and then annually, secondary patency, freedom of amputation and mortality.

Methods

The patients, who underwent a surgical or endovascular repair of PAA from August 2011 to May 2018, were retrospectly reviewed. All procedures were performed at the “Policlinico Tor Vergata” of Rome, in the angiographic room or in the operating room. Altogether 49 surgical interventions were performed in 41 patients, 39 men and 2 women, with an average age of 73 years. OPEN treatment was used in 20 cases and in 29 cases endovascular treatment. 25 patients had bilateral aneurysm with an average transverse diameter of 35 mm. Both elective and emergency patients were included in the paper writing service online.

All patients were subjected to ecocolorDoppler and angio-Tc before surgery, except the patients with acute ischemia IIb and III, according to Rutherford, who were submitted to operating room after performing ecocolorDoppler.

The asymptomatic patient was treated for aneurysm with a maximum transverse diameter greater than 2.5 cm. While in the asymptomatic the indication was related to the clinical condition of the patients.

OPEN treatment was performed both with a posterior approach, aneurysmectomy and packing of an inverted autologous saphenous vein, when a caliber>5 mm was measured with preoperative ecocolordoppler, as with a medial approach by performing autologous synthetic bypass (Dacron knitted or PTFE heparin bonded 7 and 8 mm). The choice of the method took into account the extent of the pathology, the comorbidity of the patient, the presence of insufficient venous assests and the operator's preference are have been shown in Table 1. In the selection criteria, the preference for ENDO intervention was suggested by the absence of outflow and the onset of symptoms <12 hours. We evaluate, for the endovascular feasibility, the proximal and distal landing zones, which should in both cases be at least 2 cm. Even the distal run-off has been of great importance in the choice, in fact there must be at least one tibial vessel. The choice of diameter was performed on the basis of ultrasound appearance and based on angiographic evidence after fibrinolysis. An endograft oversized of at least 10-15% of the landing zone was performed. When more than one stent was needed, an overlap of about 2 cm was repeated to prevent the onset of endoleak III. Overlapping stents differed in diameter for not more than 2 mm. In the presence of custom essay writer, ballooning and / or stenting was performed if necessary.

Endovascular interventions were performed both in the angiographic room and in the operating room. Patients with mild to moderate acute ischemia (Rutherford classification I-IIa), with acute thrombosis of the aneurysmatic sac, were subjected to urokinase preoperative local-regional thrombolysis. Thrombolytic treatment provided a bolus of 100,000 U.I. Followed by a continuous infusion of 70,000 U.I./h and 1000 to 1500 U.I./h of sodium heparin with the objective of doubling the normal value of partial thromboplastin. The continuous infusion of thrombolytic occurred for 24, 48 or 36 hours, according to the restoration of the patency of the poplite artery and at least one tibial vessel. OPEN surgery was performed at least 24 hours after cessation of thrombolytic infusion.