Materiały źródłowe

• #1 Popliteal artery aneurysm | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/popliteal-artery-aneurysm?content_id=CON-20248747

  Treatment of popliteal artery aneurysm depends on: […] Treatment may include: […] Regular health checkups. You’ll have frequent checkups and ultrasound tests to check the aneurysm, particularly if the aneurysm is small. […] Medicines. Aspirin or another blood thinner is usually prescribed for people with popliteal artery aneurysm. Medicines may need to be given through a vein. Blood pressure and cholesterol medicine may be given if you have symptoms of heart disease. […] Surgery. Open surgery to repair the damaged artery is generally recommended for any sized popliteal artery aneurysm that’s causing symptoms. Surgery is usually done for any popliteal artery aneurysm that’s 0.8 inches (2 centimeters) or larger. Sometimes, a less invasive procedure called endovascular repair may be done. During this treatment, a stent is placed inside the popliteal artery to hold it open.

• #2 Popliteal Artery Aneurysm – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430863/

  All symptomatic popliteal artery aneurysms require repair because of an increased incidence of thrombosis or limb loss. Asymptomatic aneurysms with a diameter greater than 2 cm are considered an indication for elective operation to avoid complications such as limb-threatening ischemia. Greater than 45 angulation in asymptomatic aneurysms warrants surgical intervention because of the risk of acute limb ischemia secondary to kinking of the vessel. […] Asymptomatic aneurysms less than 2 cm are safely manageable via duplex surveillance. […] Traditional open surgery involves ligation of the popliteal artery proximal (above the knee) and distal (below the knee) below the aneurysmal sac and bypassing the excluded segment using either a reversed autologous vein graft (saphenous vein) or prosthetic graft. An alternative surgical approach is aneurysmectomy, followed by an interposition bypass with a prosthetic graft between the proximal and distal normal segments of the popliteal artery. However, the former method is more common.

• #3 Popliteal artery aneurysm | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/popliteal-artery-aneurysm?lang=us

  Popliteal artery aneurysms are the most common peripheral arterial aneurysm and the second most common aneurysm after abdominal aortic aneurysms. […] Symptomatic aneurysms are treated. Asymptomatic aneurysms 2 cm in diameter are also considered for elective treatment: […] endovascular insertion of covered stent: flexible soft device (such as ViabahnTM stent graft) has better outcome due to movement at the knee crease; 5 year patency rate for ViabahnTM stent graft is 70%; disadvantages include kinking or fracture of the stent due to excessive movement […] open surgical repair (usually aneurysmorrhaphy and bypass surgery): vein graft typically used; 5 year patency rate of vein graft is also 70%.

• #4 Surgical and endovascular repair of popliteal artery aneurysm – UpToDate

  https://www.uptodate.com/contents/surgical-and-endovascular-repair-of-popliteal-artery-aneurysm

  Surgical or endovascular repair for popliteal aneurysms is indicated under the following circumstances: […] Symptomatic (eg, acute limb ischemia) popliteal aneurysm of any size […] Selected asymptomatic popliteal aneurysm (patent) depending upon diameter and presence of thrombus.

• #5 Popliteal Aneurysm Repair at UPMC: Expert Endovascular Care

  https://www.upmc.com/services/heart-vascular/services/procedures/popliteal-aneurysm-repair

  A popliteal aneurysm is a widening or bulging of the popliteal artery behind your knee. If left untreated, a popliteal aneurysm may cause blood clots that clog your artery or travel into your lower leg or foot, which can lead to the need for amputation. […] The physicians at UPMC perform open and minimally invasive endovascular repairs of popliteal aneurysms to reduce your risk of complications. […] Popliteal aneurysm repair is a procedure to reduce the risk of complications related to a popliteal aneurysm, including rupture, blood clots, or blocked arteries in the lower leg or foot. Your doctor will use a stent or another type of graft to repair the aneurysm. […] The physicians at UPMC perform open surgery and endovascular procedures to repair popliteal aneurysms. Your doctor will look at the size and placement of your aneurysm, as well as your overall health and physical condition, to determine which treatment option is right for you. Treatments include:

• #5 Popliteal Aneurysm Repair at UPMC: Expert Endovascular Care

  https://www.upmc.com/services/heart-vascular/services/procedures/popliteal-aneurysm-repair

  Endovascular treatment may be recommended for patients who are not good candidates for open surgery due to other health problems, including cardiac or pulmonary conditions. […] You might need popliteal aneurysm repair if you are diagnosed with a popliteal aneurysm, especially if it contains a blood clot. Although popliteal aneurysms rarely rupture, they can cause blood clots that may block your artery or travel into your lower leg and foot. […] You may be a candidate for popliteal aneurysm repair if your aneurysm is causing symptoms, is larger than 2 cm in diameter, or if you are at increased risk of related complications. […] Popliteal aneurysm repair is a safe and effective procedure. Complications are rare. However, like all medical procedures, it has some risks, including: […] Your popliteal aneurysm repair procedure will take 1-2 hours or longer, depending on the size of your aneurysm and the type of procedure you are having.

• #6 Popliteal Artery Disease Guidelines: SVS Guidelines for Popliteal Artery Aneurysms, ACC/AHA Guidelines for Lower-Extremity Peripheral Arterial Disease

  https://emedicine.medscape.com/article/461910-guidelines

  Guidelines on popliteal artery aneurysms (PAAs) were published in January 2022 by the Society for Vascular Surgery (SVS). The recommendations are summarized below. […] Patients with an asymptomatic PAA at least 20 mm in diameter should undergo repair to reduce their risk of thromboembolic complications and limb loss. […] Follow up patients who undergo open PAA repair (OPAR) or endovascular PAA repair (EPAR) with the use of clinical examination, ankle brachial index (ABI), and duplex ultrasonography (DUS) at 3, 6, and 12 months during the first postoperative year and, if stable, every year thereafter. […] In addition to DUS evaluation of the repair, evaluate the aneurysm sac for evidence of enlargement. If there are anomalies on clinical examination, ABI, or DUS, administer appropriate clinical management according to the lower-extremity endovascular or open bypass guidelines. In the setting of compressive symptoms or symptomatic aneurysm sac expansion, surgical decompression of the aneurysm sac is suggested.

• #7 Popliteal Artery Disease Guidelines: SVS Guidelines for Popliteal Artery Aneurysms, ACC/AHA Guidelines for Lower-Extremity Peripheral Arterial Disease

  https://emedicine.medscape.com/article/461910-guidelines

  For selected patients with an asymptomatic PAA of at least 20 mm in diameter who are at higher clinical risk of thromboembolic complications and limb loss, repair can be deferred until the PAA has become at least 30 mm, especially in the absence of thrombus. […] Consider repair for patients with a PAA smaller than 20 mm, in the presence of thrombus and a clinical suspicion of embolism or imaging evidence of poor distal runoff, to prevent thromboembolic complications and possible limb loss. […] For asymptomatic patients, with a life expectancy of at least 5 years, the SVS suggests open PAA repair, as long as there is an adequate saphenous vein present. For those whose life expectancy is diminished, if intervention is indicated, consider endovascular repair. […] Yearly monitoring for changes in symptoms, pulse examination, extent of thrombus, patency of the outflow arteries, and aneurysm diameter is suggested for patients with an asymptomatic PAA who are not offered repair.

• #8 Popliteal Aneurysm: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/popliteal-aneurysm

  A popliteal aneurysm is an enlarged section of an artery behind your knee. Open or minimally invasive surgery treats this condition. […] Popliteal aneurysm treatment varies depending on your situation. Your risk of an aneurysm breaking open increases when it gets bigger than 2 centimeters (cm) or almost 1 inch around. If your popliteal aneurysm is smaller than 2 cm and you dont have symptoms, a provider will check it regularly to make sure its not growing. […] If you have symptoms with your popliteal aneurysm and/or its larger than 2 cm (even without symptoms), a provider will do a popliteal aneurysm repair. […] In open surgery, a provider treats an aneurysm by tying off the artery above and below it (exclusion) and rerouting the blood flow (bypass). […] A provider sometimes uses an endovascular approach for people with other chronic conditions or issues that may increase the risk of complications with open surgery.

• #9 Popliteal Artery Aneurysm – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430863/

  For patients with a poor life expectancy and an asymptomatic popliteal artery aneurysm, conservative management is preferred. If treatment of a popliteal artery aneurysm is indicated for such patients because endovascular treatment is less taxing with limited postsurgical complications, endovascular popliteal artery aneurysm repair (EPAR) is preferred. […] In patients with connective tissue disorders, a lack of consensus is apparent on whether an open or endovascular approach is better for repairing a popliteal aneurysm. Endovascular interventions are relatively contraindicated because of the risk of damaging an inherently weak artery and subsequent aneurysmal degeneration. However, most reports using the endovascular approach have suggested caution with promising results. […] The prognosis is good for patients with the popliteal artery aneurysm repaired electively; surgery and endovascular procedure outcomes are similar in the short term. However, the long-term outcome of an endovascular procedure on the popliteal artery aneurysm remains unknown. In patients who present with a rupture of a popliteal artery aneurysm, the outcome is usually poor. Limb loss is common. The amputations may be above or below the knee.

• #10 Popliteal Aneurysm Treatment | UVA Health

  https://uvahealth.com/services/aortic-artery-disease/popliteal-aneurysm

  Pain in your foot or behind your knee? Swelling in your leg? Ulcers on your feet that don’t heal? These could be signs of a popliteal aneurysm. A popliteal aneurysm can burst. That can cause life-threatening, uncontrolled bleeding. The aneurysm may also cause a blood clot, which might lead to a leg amputation. […] You’ll likely need surgery to treat your popliteal aneurysm. Your surgeon will usually make a new route around the aneurysm on your artery (bypass). […] It’s important for you to carefully control your high blood pressure with medicine if needed.

• #11 Aneurysm: What It Is, Types, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22769-aneurysm

  If your provider discovers that you have an unruptured aneurysm, they’ll monitor your condition closely. The goal of treatment is to prevent the aneurysm from bursting. […] Depending on the aneurysms type, location and size, treatment can include medication or surgery. Your provider may prescribe medications to improve blood flow, lower blood pressure or control cholesterol. These treatments can help slow aneurysm growth and reduce pressure on the artery wall. […] Large aneurysms at risk of bursting may require surgery. You’ll also need surgery if an aneurysm bursts. Types of surgery may include: […] Endovascular aneurysm repair (EVAR): During endovascular surgery, your provider inserts a catheter (thin tube) into the vessel. Through the catheter, the surgeon inserts a graft (section of specialized tubing) to reinforce or repair the artery. For thoracic aneurysms, this procedure is called thoracic endovascular aneurysm repair (TEVAR). If your surgeon has to make a special graft with custom openings, the procedure may be fenestrated endovascular aneurysm repair (FEVAR).

• #12 Conservative treatment of giant popliteal aneurysm with edoxaban in an elderly man

  https://www.imrpress.com/journal/JMCM/3/1/10.31083/j.jmcm.2020.01.005/htm

  Although popliteal aneurysm is an uncommon condition, it is the most common peripheral artery aneurysm. […] The optimal management strategy for unoperated popliteal aneurysm and the prophylaxis of thromboembolism in high-risk patients remains to be determined. […] We proposed conservative treatment. We prescribed edoxaban, a direct oral anticoagulant (DOAC), 30 mg daily. […] The optimal management strategy for unoperated PA and of thromboembolism prophylaxis in high-risk patients remains unsettled. We decided to treat our patient with 30 mg of edoxaban daily, to reduce the risk of thrombosis and distal embolism. […] A conservative approach with DOACs and non-invasive periodic surveillance might be a possible strategy for the management of patients at high surgical risk, limited life expectancy, or who refuse operative repair. More research and evidence are needed to support DOAC prescription for unoperated PA.

• #13 Management of Popliteal Artery Aneurysm

  https://www.acc.org/education-and-meetings/patient-case-quizzes/management-of-popliteal-artery-aneurysm

  Management of Popliteal Artery Aneurysm […] Which of the following describes the best approach to treat this patients PAA? […] The correct answer is: Open surgical repair with reverse vein graft. […] Popliteal artery aneurysms (PAA) are the most common peripheral arterial aneurysm after the aortic-iliac segment aneurysms. Indications for repair are based on symptoms of ischemia (thrombosis or embolism), local compression or from rupture (rare). PAA 2 cm in size in asymptomatic patients is also an indication for repair to decrease risk of thrombosis or embolism. The gold standard treatment has been open surgical approach, but endovascular approach is increasingly being utilized. Studies with a large number of endovascular approaches are lacking, but current data shows higher re-intervention rates and 30-day graft thrombosis rates with endovascular approach. Suitability for endovascular and surgical risk assessment are also important factors to consider.

• #14 Popliteal Artery Aneurysms – Endovascular Today

  https://evtoday.com/articles/2003-nov/1103_08.html

  Due to the low mortality and complication rates of operative repair in contrast to the high morbidity rate when symptoms develop, most surgeons would proceed to repair any popliteal artery aneurysm 2 cm. […] Popliteal artery aneurysms can be treated by either a medial or lateral approach. The medial approach is more commonly used. […] Popliteal artery aneurysms, especially the fusiform type, are usually repaired by bypass of the aneurysmal section of the popliteal artery and ligation of the aneurysm. […] The final widely used alternative is resection of the aneurysm and bypass. […] Several studies have examined the role of preoperative thrombolytic therapy. […] With the rapid advances in endovascular technology and materials, attention has been turned to popliteal artery aneurysms.

• #15 Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms

  https://www.vsijournal.org/journal/view.html?doi=10.5758/vsi.200077

  Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. […] Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein. […] Given the motor and sensory symptoms in the lower limb, we opted for open surgical repair of the PAA. […] The decision to perform open surgery for giant PAA presenting with neurological disorder should be individualized according to the symptoms and needs of the patient. Open surgery has been selected in many patients with emergent rupture or poor runoff, infection, and giant aneurysm, and in young patients.

• #16 Popliteal Artery Aneurysm – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430863/

  Management varies according to the presentation. Asymptomatic patients with completely thrombosed popliteal artery aneurysms and those who are non-ambulatory patients or have acutely thrombosed aneurysms with a poor runoff despite thrombolysis are not candidates for surgical intervention. Only patients with disabling symptoms or critical limb ischemia are treated with surgical bypass as the first line of therapy. Patients presenting with acute limb-threatening ischemia should undergo urgent bypass. Acute thrombosis should be treated with intravenous heparin and continuous heparin infusion to limit the extension of the thrombus. However, some surgeons advise that threatening ischemia is better treated with thrombectomy, followed by bypass surgery. […] The decision analysis suggested that open repair with great saphenous vein (GSV) bypass might be considered the preferred treatment for older, asymptomatic patients with popliteal artery aneurysms.

• #17 Management of Popliteal Artery Aneurysm

  https://www.acc.org/education-and-meetings/patient-case-quizzes/management-of-popliteal-artery-aneurysm

  Our patient has already failed the endovascular approach in the past and has distal run off disease on the attached CTA. Safe endovascular approach needs at least 1 cm of normal artery to obtain adequate stent graft fixation. Based on the above factors and his lower surgical risk, open surgical repair was done in this patient, making answer A the best option. The patient is at risk of developing thrombus in the aneurysm, and, therefore, frequent examination is not the solution. Thrombolytic therapy is only required before surgery, if the patient presents with acute limb ischemia, as it improves one-year patency rates. Studies are very limited and are unable to show if warfarin sodium or antiplatelet agents alone decrease the risk of thrombosis. Therefore, other choices would not be the best answer in this case.

• #18 Evaluation, Diagnosis and Management of Popliteal Artery Aneurysms: A Clinical Review | Aguila | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/174/120

  Patients with large aneurysms and mass effect, such as venous stasis and nerve compression, are not suitable candidates for endovascular repair for the same reasons than aneurysm exclusion and bypass would not be a good option, these procedures would not resolve the mass effect of the PAA itself. […] Open ligation and bypass with greater saphenous vein is the gold standard for treatment, but novel endovascular techniques have come to play a major role in the armamentarium for intervention in both the emergency and elective scenarios.

• #19 Endovascular Treatment of Popliteal Aneurysm | Thoracic Key

  https://thoracickey.com/endovascular-treatment-of-popliteal-aneurysm/

  Endovascular repair has become a viable alternative for the treatment of popliteal artery aneurysm. […] The primary goals of repairing popliteal artery aneurysms are the prevention of thromboembolic complications and limb loss. […] Thus in all ambulatory patients, elective repair of popliteal artery aneurysms greater than 2 cm in diameter, especially those with mural thrombus, should be undertaken to prevent embolization, thrombosis, and major amputation. […] Selection of open surgical treatment or EVPAR requires an individualized assessment of the patient. […] Suitable operative candidates with adequate saphenous vein should be offered surgical repair of popliteal artery aneurysm. […] Patients undergoing endovascular repair should be able to tolerate lifelong antiplatelet therapy and potentially oral anticoagulation as well.

• #20 Popliteal Arterial Aneurysm Endovascular Repair

  https://www.sydneyvascularsurgery.com.au/popliteal-arterial-aneurysm-endovascular-repair.html

  Depending on the type of repair performed, you may have a short hospital stay of 1/2 to 2 days with a quick recovery after endovascular repair; or a longer hospital stay of 2 to 5 days with open surgery. Keep the incision clean and dry and avoid driving and lifting heavy weights for a few weeks after the repair. Follow-up imaging tests will be ordered to ensure proper functioning of the stent in endovascular repair and proper functioning of the graft in open surgery. […] As with any surgery, open and endovascular popliteal aneurysm repair may involve certain risks and complications. They include, but are not limited to: Blood leakage around the graft, Infection, Blocked blood flow within the graft, Graft migration, Death.

• #21 Popliteal Aneurysm Repair at UPMC: Expert Endovascular Care

  https://www.upmc.com/services/heart-vascular/services/procedures/popliteal-aneurysm-repair

  During an endovascular repair, your doctor will: […] The stent graft will help prevent a blood clot from moving to and blocking your leg and knee arteries. It also will prevent rupture of the aneurysm. […] During an open repair, your surgeon will: […] When the procedure is completed, you will be moved to recovery for observation and to address any issues you may have with pain. Endovascular procedures usually involve a quicker recovery and shorter hospital stay than open surgery. […] Most people make a full recovery within 4-6 weeks. It is very important that you see your doctor for follow-up visits as recommended. […] Popliteal aneurysm repair can reduce your risk of complications, including amputation. Most people live a normal, active life after popliteal aneurysm repair. […] Popliteal aneurysm repair successfully prevents limb loss and reduces the risk of long-term complications in more than 90 percent of patients.

• #22 Popliteal Artery Aneurysm – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430863/

  Recently, endovascular techniques have gained popularity in popliteal artery aneurysm repair as an alternative to the open surgical approach. This technique excludes the aneurysmal sac with stent-graft implantation. Recent studies show that popliteal artery stenting is a safe alternative technique for the treatment of popliteal artery aneurysms, especially in high-risk patients. The advantages of the endovascular technique include a shorter hospital stay and an abbreviated surgical time compared to open surgical intervention. Disadvantages include higher 30-day graft thrombosis rates (9% in the endovascular treatment group versus 2% in the open surgical treatment group) and higher 30-day re-intervention rates (9% in the endovascular treatment group versus 4% in the open surgical treatment group). The 2 repair groups have no significant difference in mortality or limb loss rates. Other reviews have also concurred that endovascular and open repair of popliteal artery aneurysms is safe.

• #23 Popliteal Arterial Aneurysm Endovascular Repair

  https://www.sydneyvascularsurgery.com.au/popliteal-arterial-aneurysm-endovascular-repair.html

  Popliteal aneurysms can be treated by two methods: open surgical repair, in which a bypass is created around the aneurysm for improving the flow of blood; or endovascular popliteal aneurysm repair, whereby a stent-graft (a tube made of fabric with a metal mesh) is inserted into the area of the aneurysm to support the bulged artery. […] Endovascular repair: This is a minimal invasive procedure which involves inserting a catheter (long flexible tube) over a guide wire, into the artery of the groin and guiding it to the aneurysm. Your surgeon may administer medications through the catheter to dissolve any blood clots. A stent-graft is then inserted through the catheter and expanded inside the artery at the location of the aneurysm. This procedure prevents an aneurysm rupture and the risk of blood clots and blockage of the artery.

• #24 Popliteal Aneurysm: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/popliteal-aneurysm

  If you have a blood clot in your leg and its causing lack of blood flow, the treatment is different. In this case, a provider may start by placing you on blood thinners (heparin) through an IV. […] Complications of popliteal aneurysm treatment may include: Blood clots to the leg (embolism). […] After open surgery, you may be in the hospital for two to three days. Recovery time tends to be shorter for an endovascular approach.

• #25 Endovascular treatment of popliteal artery aneurysm in high-risk surgical patients | Cirugía Española (English Edition)

  https://www.elsevier.es/es-revista-cirugia-espanola-english-edition–436-articulo-endovascular-treatment-popliteal-artery-aneurysm-S2173507722001132

  Endovascular treatment of popliteal artery aneurysm in high-risk surgical patients […] Asymptomatic PAs will be treated as long as they are larger than 2cm and all symptomatic PAs will be treated. The classical treatment of PA is exclusion of the aneurysm followed by revascularisation of the limb by bypass, autogenous vein or prosthesis. […] However, with the growth and development of the endovascular technique, new grafts and optimisation of antiplatelet therapy, increasingly better results are being achieved. […] Although the gold standard continues to be surgical treatment (aneurysm exclusion and bypass), with the improvement of available grafts, endovascular treatment of PA is becoming a safe and valid technique that shows advantages over open surgery in older patients with many comorbidities and in patients with saphenous vein of inadequate quality, as in the cases we have presented.

• #26 Endovascular treatment of popliteal artery aneurysm in high-risk surgical patients | Cirugía Española (English Edition)

  https://www.elsevier.es/es-revista-cirugia-espanola-english-edition–436-articulo-endovascular-treatment-popliteal-artery-aneurysm-S2173507722001132

  The advantages of endovascular treatment are less invasive compared with conventional surgery. There is no need for general anaesthesia, there is less bleeding of the limb and a shorter procedure and hospitalisation time. […] For these reasons it was the technique of choice in our cases: the first, an elderly patient with comorbidities and a history of acute thrombosis of the contralateral PA with a poor outcome, who presented thromboembolism distal to the PA with a high risk of limb loss; and the second, an obese patient with a poor quality vein for bypass. Both patients had a favourable anatomy for endovascular treatment. […] With the improvement of available grafts, the implementation of temporary dual antiplatelet therapy and improved technique development, endovascular treatment of PA is becoming a safe and valid technique in older patients at high surgical risk.

• #27 Minimally invasive versus surgical treatment of an aneurysm of the popliteal artery | Cochrane

  https://www.cochrane.org/CD010149/PVD_minimally-invasive-versus-surgical-treatment-aneurysm-popliteal-artery

  Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) -3.40 days, 95% CI -4.42 to -2.38; P 0.001; moderate-certainty evidence). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD -119.90 minutes, 95% CI -137.71 to -102.09; P 0.001; moderate-certainty evidence).

• #28 Popliteal Artery Aneurysm Treated With Endovascular Technique and New Device: Case Report and Literature Review

  https://www.jscimedcentral.com/jounal-article-info/JSM-Heart-Surgery-Cases-and-Images/Popliteal-Artery-Aneurysm-Treated-With-Endovascular-Technique-and-New-Device:-Case-Report-and-Literature-Review-11805

  In this paper, we aimed to report an alternative endovascular treatment in a patient with an isolated popliteal artery aneurysm. […] The patient was scheduled to undergo endovascular treatment of the popliteal artery aneurysm with two covered self-expandable 8 x 100 and 10 x 75 Merit Wrapsody?. […] However in high cardiac risk patients and patients with no proper autologous vein substitute the endovascular treatment for PAA has been proved as a safety and effective therapy. […] In this study, we describe an option for endovascular treatment in a patient with an isolated popliteal aneurysm with a new device. […] The advantages of endovascular repair are low invasiveness, minor blood loss; and a short duration of intervention. […] Endovascular treatment with Merit Wrapsody covered stents for PAA seems to be a safety and effective alternative for treating minimally invasive this condition, leading to an adequate flow sealing and proper aneurysm exclusion.

• #29

  https://www.scielo.br/j/rcbc/a/6PXZp9byK5jBXKXKmzZY67S/

  Among the advantages of the endovascular treatment of the popliteal artery aneurysm, there are the following: minimally invasive procedure, requiring only small incisions or catheterization by the Seldinger technique; reduced operative time; less postoperative morbidity; and early mobilization, thus shortening hospital stay. […] The results of this study are similar to other published series. There is no denying the allure of endovascular treatment, particularly with regard to more comfortable postoperative recovery. However, the placement of a stent in that location is a challenging measure, both from a technical point of view and from a careful evaluation of the results in the medium and long term. […] It is believed that with the development of new devices that support the mechanical characteristics found on the popliteal region, there will be improvement in the performance and outcome of endovascular restoration in the near future.

• #30 Popliteal artery aneurysms | Gore Medical Asia Pacific

  https://www.goremedical.com/ap/products/viabahn/clinical-uses/popliteal-artery-aneurysms

  Endovascular treatment of popliteal artery aneurysms (PAAs) is associated with reduced operative time, perioperative morbidity, hospital stay, and recovery time compared to open surgery. […] The GORE VIABAHN Endoprosthesis is an established PAA treatment option associated with short and mid-term clinical results that are comparable to surgical bypass. […] The GORE VIABAHN Endoprosthesis with PROPATEN Bioactive Surface is an excellent alternative to surgical repair of popliteal aneurysms and offers lower morbidity as well as a shorter length of stay.

• #31 Treatment of a large popliteal aneurysm | Gore Medical Asia Pacific

  https://www.goremedical.com/ap/products/viabahn/case-studies/popliteal-artery-aneurysms

  The new, low-profile 0.018″ compatible GORE VIABAHN Endoprosthesis with PROPATEN Bioactive Surface* is ideal for treatment of popliteal aneurysms. […] The GORE VIABAHN Endoprosthesis with PROPATEN Bioactive Surface* is an excellent alternative to surgical repair of popliteal aneurysms and offers lower morbidity as well as a shorter length of stay.

• #32 Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00514-7

  Popliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. […] PAAs need urgent treatment in case of acute limb ischemia (ALI) due to acute aneurysm thrombosis or distal embolization to tibio-pedal arteries and in the cases of aneurysm rupture. […] In patients with ALI, intervention should be defined according to the severity of ischemia (Rutherford clinical categories of ALI). […] In case of PAA thrombosis and loss of tibio-pedal runoff arteries, with mild/moderate ALI, intra-arterial thrombolysis is indicated to restore runoff for a subsequent surgical treatment. […] Patients with limb threatening ischemia should urgently undergo surgical or endovascular revascularization, possibly with adjunctive procedures as mechanical or aspiration thrombectomy of runoff vessels.

• #33 Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00514-7

  In case of irreversible ALI, a primary major amputation is needed. […] Ruptured PAA can threaten both patients limb and life and can be surgically treated with ligation or bypass grafting. Endovascular treatment utilizing stent-graft placement is also a viable option. […] The aim of the present study was to evaluate an 11-year experience in the urgent treatment of PAAs according to their clinical presentation (ALI or rupture) in two vascular centers. […] In our series, preoperative intra-arterial thrombolysis was performed in 18 (33%) patients, and it was associated with higher long-term survival rate if compared to urgent bypass surgery alone (5-year survival 946% vs. 6210%, P=0.03). […] Thrombolysis may be used preoperatively in patients with mild to moderate ischemia (Rutherford I or IIa) to improve the tibio-pedal runoff, if not contraindicated.

• #34 Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00514-7

  An interesting finding of our study is the independent association of number of patent tibial arteries (pTA) with long-term survival during follow-up. […] Moreover, the number of pTA was independently associated with limb salvage during follow-up. […] According to these data, in case of symptomatic PAA with ALI due to aneurysm thrombosis or distal embolization, obtaining as many pTA as possible by means of preoperative catheter-directed intra-arterial thrombolysis and/or intraoperative tibial arteries thrombectomy may provide better long-term survival and limb salvage rates. […] Data about long-term outcomes of urgent PAA surgical treatment are limited; however, a prompt treatment ensures generally favorable outcomes and satisfactory long-term results. […] PAA rupture is not uncommon and accounts for nearly one fifth of cases requiring urgent treatment, often associated with low long-term survival rates. […] Patients experiencing ALI, but not facing limb threatening ischemia, can benefit from preoperative thrombolysis since their limb salvage and survival during follow-up are closely linked to the number of pTA.

• #35 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  Improvements in stent-grafts and endovascular techniques in general have extended the treatment options for lesions in different vascular territories, including patients with PAA. Endovascular repair of PAA has emerged as a reasonable treatment option in patients with favorable anatomy. […] However, currently available data on the endovascular management of acute complications of the PAA are limited. This is very important in that thrombosis and distal embolization resulting in acute limb ischemia are the most common complications of PAA and are associated with a high risk for amputations. […] A Mayo study evaluated 25 patients (31 limbs) who underwent elective (61%) and emergency (39%) endovascular PAA repair. […] The results of this study showed that elective endovascular PAA repair is technically feasible in elective and emergency settings and suggested that elective endovascular PAA repair is reasonable in anatomically suitable patients with increased risk for open repair.

• #36 Popliteal Aneurysm Repair – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563185/

  Open surgical bypass and endovascular stent placement are both options in treating popliteal artery aneurysms, and there is an open-ended debate regarding which is preferred. A meta-analysis revealed that endovascular repair had lower wound complication rates and shorter length of stay than open repair; however, there was decreased primary patency at 3 years. […] Open Repair requires the following types of equipment: Operating room suite, Personal protective equipment (mask, eye protection, bouffant, sterile gown, sterile gloves), Skin prep, Sterile drapes, Ultrasound, Intravenous heparin, Heparinized saline, Electrocautery, Standard vascular tray including scalpels (11 and 15 number blades), Castroviejo needle driver, tissue forceps, scissors, self-retaining retractors, vessel loops, bulldog clamps, and vascular clamps, A combination of suture and ties per surgeon preference (silk, polyglactin, poliglecaprone, and polypropylene), Doppler to assess patency and flow intraoperatively.

• #37 Minimally invasive versus surgical treatment of an aneurysm of the popliteal artery | Cochrane

  https://www.cochrane.org/CD010149/PVD_minimally-invasive-versus-surgical-treatment-aneurysm-popliteal-artery

  Evidence to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs is limited to data from one small study. […] At four years there was no clear benefit from either endovascular stent graft or surgery to primary or assisted primary patency (moderate-certainty evidence). […] A large multicenter RCT may provide more information in the future. […] PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. […] The primary patency rate at one year was 93.3% in the endovascular group and 100% in the surgery group (RR 0.94, 95% CI 0.78 to 1.12; moderate-certainty evidence).

• #38 Popliteal artery aneurysm – Wikipedia

  https://en.wikipedia.org/wiki/Popliteal_artery_aneurysm

  It is unclear whether stenting or open surgery is a better for those with aneurysms that are not causing symptoms.

• #39 Popliteal Aneurysm Repair – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563185/

  Endovascular repair requires the following personnel: Surgeon, Anesthesiologist, First Assistant, Nursing staff (circulator and scrub tech), Radiology technician. […] Complications of open popliteal artery aneurysm repair either by medial or posterior approach include: Wound complications, Sac expansion, Vein graft aneurysm, Graft failure. […] Complications of popliteal artery stenting are similar to other peripheral artery stents. These include: Access site complications (including hematoma, pseudoaneurysm), Stent kinking, migration, fracture, thrombosis, or endoleak. […] Popliteal artery aneurysms, although rare, may put the affected limb at risk. Any symptomatic aneurysm, or 1 larger than 2 cm, should be considered for repair as above. Endovascular repair has been shown to decrease the length of stay and wound complications; however, its durability is inferior. The decision regarding open or endovascular repair should be individualized, and the risks and benefits of each should be discussed with the patient.

• #40

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1769

  A popliteal aneurysm is a bulge in a blood vessel (artery) behind your knee. […] A small aneurysm may not need surgery, although your doctor will watch it closely. […] Follow-up care is a key part of your treatment and safety. […] Call your doctor or nurse advice line now or seek immediate medical care if: […] You have sudden pain in your leg or foot. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any problems.

• #41 SVS releases clinical practice guidelines on popliteal artery aneurysms

  https://vascularnews.com/svs-releases-clinical-practice-guidelines-on-popliteal-artery-aneurysms/

  Popliteal artery aneurysms can cause limb loss and therefore early diagnosis, careful follow-up, and timely treatment of this condition are paramount. […] Surgical bypass and endovascular stent-grafting, both have a role in treatment of appropriately selected patients and these interventions can prevent leg amputation. […] The goal of treatment should be to prevent aneurysm complications including amputation, and to allow for a patient’s rapid return to their baseline functional level. These guidelines should greatly aid in the achievement of these goals.

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