Superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysm: Long-term outcome

• Published in: Journal of vascular surgery Vol. 48; no. 2; pp. 311 - 316
• Main Authors: Paraskevas, Nikolaos, MD, Castier, Yves, MD, PhD, Fukui, Sumio, MD, Soury, Patrick, MD, Thabut, Gabriel, MD, Leseche, Guy, MD, Laurian, Claude, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2008; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm - complications; Aneurysm - diagnostic imaging; Aneurysm - surgery; Aortography; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Femoral Artery - transplantation; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Male; Medical sciences; Middle Aged; Popliteal Artery; Postoperative Care - methods; Postoperative Complications - physiopathology; Preoperative Care - methods; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue and Organ Harvesting; Transplantation, Autologous; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Superficial femoral artery; Autograft; Prognosis; Treatment; Surgery; Popliteal artery; Cardiovascular disease; Artery aneurysm
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.03.058

Objective This prospective, observational study evaluated the safety and efficacy of superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysms in the absence of a suitable saphenous vein. Methods From March 1997 to April 2007, data from patients with popliteal artery aneurysms treated by superficial femoral artery reconstruction were prospectively collected in two centers. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction, and the harvested segment was replaced by a polytetrafluoroethylene graft. The patients were observed for survival, limb salvage, and reconstruction patency. The results were calculated by the Kaplan-Meier method. Results During the 10-year study period, 37 popliteal artery aneurysms in 32 patients (all men; median age, 71 years) were treated by reconstruction using the superficial femoral artery. Indications for surgical treatment were symptomatic or complicated aneurysms in 11 (30%). Four (11%) of the 37 popliteal artery aneurysms were thrombosed, and 33 (89%) were patent. At surgery, 35% had a single vessel runoff. Because of acute ischemia, reconstruction was performed as an emergency procedure in three patients (8%). There were no perioperative deaths, early amputations, or early thrombosis. The mean follow-up period was 36 months (range, 7-103 months). Two grafts thrombosed during follow-up. At 3 years, the primary and secondary patency rates were 86% and 96%, and overall limb salvage was 100%. Follow-up duplex ultrasonography did not detect any aneurysmal dilatation of the autograft. Conclusion Our experience shows that superficial femoral arterial reconstruction is a safe and useful treatment option in patients with popliteal artery aneurysms who lack suitable saphenous veins. This reconstruction seems to be a good alternative to prosthetic bypass crossing the knee joint, and our results suggest that this study should be continued.