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Comparative therapeutic effectiveness of endovascular vs. open surgical repair for popliteal artery aneurysms
JVIR
’
Scientific Session
Wednesday
Results: 115 patients (79 male, mean age 52.3) met the diagnostic criteria for SAM. Abdominal pain was the most common presentation (70%) followed by flank pain (21%). SAM most commonly affected the renal arteries (45%), superior mesenteric artery (44%), celiac trunk (44%), hepatic artery (22%), iliac arteries (17%) and the splenic artery (14%). The most common imaging findings were dissection (83%), aneurysm (56%), beading/webs (27%), occlusion (18%) and a rind or wall thickening (15%). 252 follow up imaging studies (mean time 21.8 ⫾ 28.3 months) showed progression in 19 patients (16.5%). 60 (52.2%) patients showed stability and 36 patients (31.3%) showed regression or improvement. Of the 66 patients who had imaging of the head and neck, 14 (21.2%) had abnormalities. Conclusions: SAM most commonly affects the renal arteries, superior mesenteric artery and celiac artery. Dissections and aneurysms are the most common imaging finding. Follow up imaging studies showed regression or stability in the majority of patients. Head and neck arterial involvement is relatively common. As such, consideration to head and neck imaging should be given in SAM patients.
4:21 PM
Abstract No. 400
Comparative therapeutic effectiveness of endovascular vs. open surgical repair for popliteal artery aneurysms M. Zuo1, C. Lee1, P. Rossi1, S. White1, R. Hieb1, P. Patel1; 1 Medical College of Wisconsin, Milwaukee, WI Purpose: Popliteal artery aneurysms (PAA) are the most common peripheral artery aneurysms and account for 70% of all aneurysms found in lower extremities. In the past, open surgical repair by bypass grafting has been the main
’
S173
treatment strategy; but in recent years, the treatment paradigm for PAA repair has observed a shift toward the increasingly popular endovascular stenting with Hemobahn/Viabahn endografts due to the minimally invasive nature of the practice and that the stent grafts are highly flexible, self-expanding and less susceptible to fracture or migration. Therefore, the purpose of this study is to determine which treatment type is more therapeutically effective in treating PAA. Materials: This was an IRB approved multicenter retrospective observational study. Hospital records were queried for patients undergoing open or endovascular repair of PAA from 1/1/2009 to 3/19/2014. Patient demographics, primary patency, limb salvage rates, length of hospital stay (LOS) and rates of post-operative complications of endovascular vs. open surgical repair of PAA were documented. Results: 29 patients underwent endovascular repair and 8 underwent open PAA repair. The mean age of the patients were 72 (range 57-88). There was no differences in primary patency (hazard ratio ¼ 0.46, p ¼ 0.18), limb salvage rates (100% vs.100%, p ¼ 1.00) and rates of postoperative complications (0% vs.12.5%, p ¼ 0.22) between endovascular repair vs. open repair. However, endovascular repair resulted in shorter LOS (2 days vs. 6 days, po0.05). Meanwhile, patients who underwent endovascular repair tended to be older (po0.05) than open repair patients. Conclusions: Given the ongoing debate of endovascular vs. open repair of PAA, the findings from this study are congruent with the existing literature, suggesting that while the two treatment types offer similar therapeutic effectiveness, the endovascular repair resulted in shorter LOS. Our study also suggests a propensity for providers to utilize endovascular repair for older patients. Bearing the rising cost of health care in mind, future studies could potentially evaluate the relative cost-effectiveness of the two treatment types.
WEDNESDAY: Scientific Sessions
’
Scientific Session
Wednesday
Results: 115 patients (79 male, mean age 52.3) met the diagnostic criteria for SAM. Abdominal pain was the most common presentation (70%) followed by flank pain (21%). SAM most commonly affected the renal arteries (45%), superior mesenteric artery (44%), celiac trunk (44%), hepatic artery (22%), iliac arteries (17%) and the splenic artery (14%). The most common imaging findings were dissection (83%), aneurysm (56%), beading/webs (27%), occlusion (18%) and a rind or wall thickening (15%). 252 follow up imaging studies (mean time 21.8 ⫾ 28.3 months) showed progression in 19 patients (16.5%). 60 (52.2%) patients showed stability and 36 patients (31.3%) showed regression or improvement. Of the 66 patients who had imaging of the head and neck, 14 (21.2%) had abnormalities. Conclusions: SAM most commonly affects the renal arteries, superior mesenteric artery and celiac artery. Dissections and aneurysms are the most common imaging finding. Follow up imaging studies showed regression or stability in the majority of patients. Head and neck arterial involvement is relatively common. As such, consideration to head and neck imaging should be given in SAM patients.
4:21 PM
Abstract No. 400
Comparative therapeutic effectiveness of endovascular vs. open surgical repair for popliteal artery aneurysms M. Zuo1, C. Lee1, P. Rossi1, S. White1, R. Hieb1, P. Patel1; 1 Medical College of Wisconsin, Milwaukee, WI Purpose: Popliteal artery aneurysms (PAA) are the most common peripheral artery aneurysms and account for 70% of all aneurysms found in lower extremities. In the past, open surgical repair by bypass grafting has been the main
’
S173
treatment strategy; but in recent years, the treatment paradigm for PAA repair has observed a shift toward the increasingly popular endovascular stenting with Hemobahn/Viabahn endografts due to the minimally invasive nature of the practice and that the stent grafts are highly flexible, self-expanding and less susceptible to fracture or migration. Therefore, the purpose of this study is to determine which treatment type is more therapeutically effective in treating PAA. Materials: This was an IRB approved multicenter retrospective observational study. Hospital records were queried for patients undergoing open or endovascular repair of PAA from 1/1/2009 to 3/19/2014. Patient demographics, primary patency, limb salvage rates, length of hospital stay (LOS) and rates of post-operative complications of endovascular vs. open surgical repair of PAA were documented. Results: 29 patients underwent endovascular repair and 8 underwent open PAA repair. The mean age of the patients were 72 (range 57-88). There was no differences in primary patency (hazard ratio ¼ 0.46, p ¼ 0.18), limb salvage rates (100% vs.100%, p ¼ 1.00) and rates of postoperative complications (0% vs.12.5%, p ¼ 0.22) between endovascular repair vs. open repair. However, endovascular repair resulted in shorter LOS (2 days vs. 6 days, po0.05). Meanwhile, patients who underwent endovascular repair tended to be older (po0.05) than open repair patients. Conclusions: Given the ongoing debate of endovascular vs. open repair of PAA, the findings from this study are congruent with the existing literature, suggesting that while the two treatment types offer similar therapeutic effectiveness, the endovascular repair resulted in shorter LOS. Our study also suggests a propensity for providers to utilize endovascular repair for older patients. Bearing the rising cost of health care in mind, future studies could potentially evaluate the relative cost-effectiveness of the two treatment types.
WEDNESDAY: Scientific Sessions