Advanced

Results After Open and Endovascular Repair of Popliteal Aneurysm : A Matched Comparison Within a Population Based Cohort

Cervin, Anne ; Acosta, Stefan LU ; Hultgren, Rebecka ; Grip, Olivia ; Björck, Martin and Falkenberg, Mårten (2021) In European Journal of Vascular and Endovascular Surgery
Abstract

Objective: To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. Methods: A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 – 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 – 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Results: Patients in the ER group were older (73 vs. 68 years, p =... (More)

Objective: To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. Methods: A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 – 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 – 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Results: Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 – 4.55, p < .001) for ER, but 3.03 (1.26 – 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 – 4.50, p = .003), but 4.68 (1.89 – 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 – 5.97], p = .003; and poor outflow HR 14.39 [3.46 – 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 – 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 – 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 – 2012 and 2014 – 2018). Conclusion: In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Case–control study, Endovascular, Occlusion, Open surgery, Popliteal artery aneurysm, Stent graft
in
European Journal of Vascular and Endovascular Surgery
publisher
Elsevier
external identifiers
  • pmid:33762154
  • scopus:85103343615
ISSN
1078-5884
DOI
10.1016/j.ejvs.2021.02.007
language
English
LU publication?
yes
id
2773b809-ad5a-42d6-bb60-9bd226866c64
date added to LUP
2021-04-08 12:56:48
date last changed
2021-04-09 03:00:03
@article{2773b809-ad5a-42d6-bb60-9bd226866c64,
  abstract     = {<p>Objective: To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. Methods: A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 – 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 – 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Results: Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p &lt; .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 – 4.55, p &lt; .001) for ER, but 3.03 (1.26 – 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 – 4.50, p = .003), but 4.68 (1.89 – 11.62, p &lt; .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 – 5.97], p = .003; and poor outflow HR 14.39 [3.46 – 59.92], p &lt; .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 – 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 – 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p &lt; .001). Indications and outcomes were similar during both time periods (2008 – 2012 and 2014 – 2018). Conclusion: In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.</p>},
  author       = {Cervin, Anne and Acosta, Stefan and Hultgren, Rebecka and Grip, Olivia and Björck, Martin and Falkenberg, Mårten},
  issn         = {1078-5884},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {Results After Open and Endovascular Repair of Popliteal Aneurysm : A Matched Comparison Within a Population Based Cohort},
  url          = {http://dx.doi.org/10.1016/j.ejvs.2021.02.007},
  doi          = {10.1016/j.ejvs.2021.02.007},
  year         = {2021},
}