P-095 - SPIRAL VEIN-GRAFT TECHNIQUE FOR POPLITEAL ARTERY ANEURYSM REPAIR IS A VIABLE ALTERNATIVE TO CONVENTIONAL AUTOLOGOUS VEIN-GRAFT.

TOPIC:
Peripheral Arterial Aneurysms
AUTHORS:
Gleditsch E. (Department of Vascular Surgery, Haukeland University Hospital ~ Bergen ~ Norway) , Gubberud E. (Department of Vascular Surgery, Haukeland University Hospital ~ Bergen ~ Norway) , Johnsen L. (Department of Vascular Surgery, Haukeland University Hospital ~ Bergen ~ Norway) , Verthus M. (Department of Vascular Surgery, Stavanger University Hospital ~ Stavanger ~ Norway) , Jonung T. (Department of Clinical Sciences, University of Bergen ~ Bergen ~ Norway) , Hjellestad I. (Department of Medicine, Haukeland University Hospital ~ Bergen ~ Norway)
Introduction:
The present alternative treatment options for patients with popliteal artery aneurysm (PAA) without a suitable vein for conventional autologous venous bypass (in-situ or reversed) are prosthetic graft or endovascular stent graft. These treatment modalities have limited short- and long-term durability1,2. In 2016, a pilot study of five PAA patients without suitable autologous veins for conventional bypass surgery was published3. The patients were treated using the spiral vein-graft technique (SVT). The results were encouraging. The present study aimed to evaluate the SVT as a surgical treatment option for PAA by comparing patency following SVT to conventional PAA treatment with autologous venous bypass.
Methods:
From October 2016 to April 2021, 32 patients underwent 40 elective bypass surgery procedures for PAA using autologous vein material, of which eight patients had bilateral surgery. Seventeen SVTs were performed on 16 patients. In the control group, 23 conventional autologous venous bypasses were performed using either in-situ (n=7) or reversed venous (n=16) bypass. The number of crural run-off arteries and PAA size were measured using CT-angiography. In the SVT group, either the ipsilateral great saphenous (n=15) or the small saphenous vein (n=2) were harvested. In two cases, the superficial accessory vein was harvested and combined with the small saphenous vein. The ipsilateral great saphenous vein was used in the control group for all patients. The spiral vein grafts (SVG) were constructed by splitting the harvested vein longitudinally and suturing the vein in a spiral fashion around a sterile plastic syringe (2.5 mL, 8 mm diameter) by continuous sutures. The length of the SVG was matched to the need in each case. The posterior approach to the popliteal artery and the inlay technique was used.
Results:
During 12 months follow-up, percutaneous angioplasty (PTA) was required in one bypass in the SVT group, whereas reintervention was needed in eight bypasses in the control group. Accordingly, the primary patency of the SVGs was 94% at 12 months compared to 65% of the conventional autologous venous bypasses. Intermediary results of primary patency in the SVG were 100% and 94% at 30 days and six months follow up, respectively, compared to 91% and 74% of the conventional autologous venous bypasses. Secondary patency was 100% in the SVT group, compared to 91% in the control group at 30 days, 6mnd and 12mnds follow-up. In the control group, two of the bypasses occluded at day 6 and 8 postoperatively and were lost. One patient had a persisting postoperative leakage to the aneurism sack and was treated with percutaneous coiling, one needed revision of the distal anastomosis and thromboembolectomy. Four bypasses were treated with percutaneous angioplasty (PTA), of which two were occluded and received thrombolysis prior to the PTA. No differences in age, gender, BMI and smoking status were seen between the groups at baseline.
Conclusion:
The spiral vein-graft technique is a viable method to treat PAA in selected patients without a sufficient autologous vein for conventional venous bypass.
References:
1. Pulli R, Dorigo W, Castelli P, Dorrucci V, Ferilli F, De Blasis G, et al. A multicentric experience with open surgical repair and endovascular exclusion of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2013 Apr;45:357e63. 2. Leake AE, Segal MA, Chaer RA, Eslami MH, Al-Khoury G, Makaroun MS, et al. Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg 2017 Jan;65: 246e56. 3. Pedersen G, Gleditsch E, Johnsen L, Gubberud E. Spiral Vein-Graft Technique for Popliteal Artery Aneurysms. EJVES Short Rep. 2019 May 15;43:21-23.