Ruptured PAA has the worse prognosis. In this study, a patient presented with ruptured PAA, who was in the early postoperative stage (– 30 days) suffered from a critical ischemia, which led to an above knee amputation. Similarly, the infected PAA share the same postoperative results. In this study, another patient also suffered from an infected PAA, which also has led to above knee amputation.
In this particular study, we focused on the results of a PAA surgical repair. The posterior approach applies relatively the same principle as in the treatment of the AAA open technique using resection of the PAA with interposition (end-to-end anastomosis) vein or prosthetic grafting.5 The medial approach provides a revascularization therapy with good access to healthy proximal and distal artery without the resection of the PAA sac. In a posterior repair, there is a reduced possibility of future sac expantion.4 However; there is a higher risk of nerve damage.3&6
This study showed a similar primary patency rates (posterior approach had a 93%, 70% and 63% while the medial approach had a 75%, 65% and 50%) in 6-month, 1-year and 2- year intervals.
Dorweiller et al showed a primary patency rate of 88% and Davis et al showed 63%.
Poor runoff (zero to less than 2) was linked to worse primary patency. In this study, patients with PAA and preoperative runoff <2 showed a primary patency of 61%, 44% and 33% in comparison to patients who had a runoff >2 (91%, 74%, and 63%) in 6 months, 1 year and 2 year interval.
This study also shows that vein material as a graft with better patency rates (100%, 76% and 67%) than a prosthetic graft (83%, 83% and 33%).
The paper, “The Posterior Approach in the Treatment of Popliteal Artery Aneurysm: Feasibility and Analysis of Outcome” details the use of anticoagulation after PAA repair.7 in this study, 24 patients received anticoagulant therapy using warfarin and 3 used Rivaroxaban.
There has not been much focus in other studies on the below knee runoff as a variable for comparing the primary patency related to PAA repair. By doing a review on the results and using the runoff as a comparing factor, we found that in the posterior approach group with using a vein bypass, the 1-year-primary patency was 100% even in the group with a poor runoff, while the results were with lower in the medial approach group. Though, in both approaches, the results were only with 50% patency rates after 2 years.
For the group with better runoff (>2), the patency rates were 100%, 74% and 68% in the posterior approach using the vein as a graft material. In the medial approach group, with similarly using the vein graft, the results were 83%, 67% and 67%.
Astonishingly, in the first year, the medial approach with a prosthetic graft showed better results compared to the posterior approach in the runoff > 2 group (83% primary patency versus 67%) but in 2 years, the posterior approach group has a better patency rate (67% versus 33%).
Conclusion
The results of the PAA confirm that surgical repair is a safe procedure. The choice of which approach to perform is still a debate. Vein graft shows a better result in PAA. A big concern should be taken of the runoff situation.
Limitation
Concerning the postoperative anticoagulants, not all patients received the same therapy. By using the prosthetic bypasses, the bypass materials were not identical.
Acknowledgements
I want to acknowledge Prof. Dr. Wozniak for advising me and reviewing my work every step of the way.
References
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