O-143 - THE GREAT SAPHENOUS VEIN IS THE IDEAL GRAFT FOR THE SURGICAL TREATMENT OF POPLITEAL ANEURYSMS

TOPIC:
Peripheral Arterial Aneurysms
AUTHORS:
Pini R. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Faggioli G. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Ruotolo C. (Vascular Surgery - Cardarelli Hospital Napoli ~ Napoli ~ Italy) , Ficarelli I. (Vascular Surgery - Cardarelli Hospital Napoli ~ Napoli ~ Italy) , Mirandola V. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Pini A. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Rocchi C. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Angherà C. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Pomatto S. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Caputo S. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Abualhin M. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy) , Gargiulo M. (Vascular Surgery - Policlinico S. Orsola IRCCS - Bologna ~ Bologna ~ Italy)
Introduction:
Popliteal artery aneurysms (PAA) require surgical repair in order to prevent thrombosis, distal embolization and leg ischemia. The bypass should be performed with great saphenous vein (GSV) according to current guidelines, however only few and contradictory data support this recommendation. The aim of the present study is to evaluate a two-center experience in the surgical treatment of PAA, in order to analyze the outcome according to the different graft type.
Methods:
All patients surgically treated for asymptomatic PAA in two high-volume vascular centers were considered. Patients were enrolled prospectively from 2010 to 2021 evaluating clinical, anatomical characteristics and technical surgical aspects of PAA treatment. The main aim was to compare the GSV vs. prosthetic bypass (PB) patency and limb salvage according to all the considered variables. The follow-up was performed by annual clinical and duplex-ultrasound evaluation. Statistical analysis was performed by Kaplan Meier log-rank evaluation and multivariable Cox regression tests.
Results:
A total of 324 asymptomatic PAA were included in the study. The mean age was 70±11 years and 80% were male. Fifty-four percent of PAA had all the 3 tibial arteries (TA) patent , 27% 2 and 19% only one. The GSV was used in 194 (60%) and PB in 130 (40% - PTFE 90%), with the posterior approach performed in 25%. Peri-opartive major adverse cardiovascular events were similar in PAA treated with GSV or PB (12% vs 15%, P=.24) The mean follow-up was 52±21 months and the overall 5-year primary patency (PP) was 87±3%. The 5-year PP was significantly greater with GSV compared with PB, (95±2% vs. 74±6%, P=.0001), unrelated from the number of patent TA: 3TA: 94±5% vs. 78±8%, P=.001; 2TA: 94±5% vs. 75±9%, P=.001; 1 TA 100% vs. 68±20%, P=.01. Similarly, the GSV had a higher 5-year PP compared with PB both in the posterior approach and in the medial approach (98±3% vs. 85±8%, P=.01 and 95±3% vs. 76±6%, P=.01, respectively). The number of patent TA and the GSV used as a graft were independent predictors of PP: hazard ratio [HR] 0.44 (95% confidence interval [CI]0.3-0.8), P=.001; HR: 0.14 (95%CI 0.06-0.3),P=.01, respectively. The overall freedom from limb loss was 98±2% with no differences according to the type of graft used; the only predictor of 5-year limb loss was the number of patent TA (HR 0.2 (95%CI 0.05-0.8), P=.02).
Conclusion:
This experience supports current recommendations to use GSV as a bypass graft in the surgical treatment of PAA. The GSV warrants higher patency rates compared with PB, independently from the number of patent TA and from the surgical access. Nevertheless, the overall limb salvage is high at 5 year and is independent on the type of graft used.