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Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion.
J Vasc Surg. 2012 Jan; 55(1):90-7.JV

Abstract

OBJECTIVES

There are few long-term follow-up studies about the result of revascularization surgery for the treatment of popliteal artery entrapment syndrome (PAES). We performed this retrospective study to analyze the long-term result of revascularization surgery in patients with advanced PAES during the last 16 years.

METHODS

Twenty-two limbs in 18 consecutive patients with PAES were treated surgically at Seoul National University Hospital between January 1994 and December 2009. The preoperative diagnosis of PAES was made by duplex ultrasonography, three-dimensional computed tomography angiography, magnetic resonance imaging, or conventional angiography. The method of surgical approach was determined by the extent of arterial occlusion in preoperative images.

RESULTS

The mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015).

CONCLUSION

In advanced popliteal entrapment syndrome, longer bypass with superficial femoral artery inflow showed poor long-term graft patency rate. The graft patency rate was excellent in patients whose arterial occlusion was confined to the popliteal artery and treated by popliteal interposition graft with reversed saphenous vein. With these data, we suggest that longer bypass extending beyond the popliteal artery might only be indicated in patients with critical limb ischemia when the extent of disease does not allow short interposition graft.

Authors+Show Affiliations

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21944915

Citation

Kim, Seong-Yup, et al. "Long-term Outcomes After Revascularization for Advanced Popliteal Artery Entrapment Syndrome With Segmental Arterial Occlusion." Journal of Vascular Surgery, vol. 55, no. 1, 2012, pp. 90-7.
Kim SY, Min SK, Ahn S, et al. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg. 2012;55(1):90-7.
Kim, S. Y., Min, S. K., Ahn, S., Min, S. I., Ha, J., & Kim, S. J. (2012). Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. Journal of Vascular Surgery, 55(1), 90-7. https://doi.org/10.1016/j.jvs.2011.06.107
Kim SY, et al. Long-term Outcomes After Revascularization for Advanced Popliteal Artery Entrapment Syndrome With Segmental Arterial Occlusion. J Vasc Surg. 2012;55(1):90-7. PubMed PMID: 21944915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. AU - Kim,Seong-Yup, AU - Min,Seung-Kee, AU - Ahn,Sanghyun, AU - Min,Sang-Il, AU - Ha,Jongwon, AU - Kim,Sang Joon, Y1 - 2011/09/23/ PY - 2011/04/20/received PY - 2011/06/20/revised PY - 2011/06/20/accepted PY - 2011/9/28/entrez PY - 2011/9/29/pubmed PY - 2012/2/3/medline SP - 90 EP - 7 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 55 IS - 1 N2 - OBJECTIVES: There are few long-term follow-up studies about the result of revascularization surgery for the treatment of popliteal artery entrapment syndrome (PAES). We performed this retrospective study to analyze the long-term result of revascularization surgery in patients with advanced PAES during the last 16 years. METHODS: Twenty-two limbs in 18 consecutive patients with PAES were treated surgically at Seoul National University Hospital between January 1994 and December 2009. The preoperative diagnosis of PAES was made by duplex ultrasonography, three-dimensional computed tomography angiography, magnetic resonance imaging, or conventional angiography. The method of surgical approach was determined by the extent of arterial occlusion in preoperative images. RESULTS: The mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015). CONCLUSION: In advanced popliteal entrapment syndrome, longer bypass with superficial femoral artery inflow showed poor long-term graft patency rate. The graft patency rate was excellent in patients whose arterial occlusion was confined to the popliteal artery and treated by popliteal interposition graft with reversed saphenous vein. With these data, we suggest that longer bypass extending beyond the popliteal artery might only be indicated in patients with critical limb ischemia when the extent of disease does not allow short interposition graft. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/21944915/Long_term_outcomes_after_revascularization_for_advanced_popliteal_artery_entrapment_syndrome_with_segmental_arterial_occlusion_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(11)01599-0 DB - PRIME DP - Unbound Medicine ER -