Common surgical practice in the treatment of patients with popliteal artery aneurysm among vascular centers in Serbia

Aleksandar Zarić; Aleksandar Tomić; Ivan Marjanović; Vladimir Manojlović; Nebojša Budakov; Anica Ilić; Aleksandra Vujčić; Mihajlo Nešković; Igor Atanasijević; Nemanja Stepanović; Jelena Stanković; Milan Jovanović; Nenad Ilijevski; Igor Končar; Lazar Davidović

doi:10.2298/VSP220228073Z

Aleksandar Zarić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Aleksandar Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Ivan Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Vladimir Manojlović University Clinical Center of Vojvodina, Clinic for Vascular Surgery, Novi Sad, Serbia
Nebojša Budakov University Clinical Center of Vojvodina, Clinic for Vascular Surgery, Novi Sad, Serbia
Anica Ilić University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Aleksandra Vujčić University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Mihajlo Nešković “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
Igor Atanasijević “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
Nemanja Stepanović University Clinical Center Niš, Clinic for Vascular Surgery, Niš, Serbia
Jelena Stanković General Hospital Užice, Užice, Serbia
Milan Jovanović General Hospital Užice, Užice, Serbia
Nenad Ilijevski “Dedinje” Cardiovascular Institute, Clinic for Vascular Surgery, Belgrade, Serbia
Igor Končar University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Lazar Davidović University Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP220228073Z

Keywords: endovascular procedures, popliteal artery aneurysm, serbia, vascular surgical procedures

Abstract

Background/Aim. Popliteal artery aneurysm (PAA) is the most common peripheral artery aneurysm and the second most common aneurysm following abdominal aortic aneurysm (AAA). Still, its incidence is rare, and treatment is non-standardized. The collection of data in a multicenter registry could improve the diagnosis and treatment of PAA. SerbVasc is a newly established data collection collaboration among vascular centers in Serbia. The aim of this study was to present common surgical practices in the diagnosis and treatment of patients with PAA in hospitals in Serbia. Methods. Vascular centers in Serbia that accepted the invitation collected data retrospectively concerning patients operated on for PAA from 2012 to 2018. Data regarding symptoms, preoperative diagnostics, vascular and endovascular techniques, and postoperative results were collected. This data set was submitted to the VASCUNET international project of PAA for data analysis between the countries. The same data set was used for a detailed analysis of the contemporary treatment of PAA in six hospitals in Serbia: University Clinical Center of Serbia, “Dedinje” Cardiovascular Institute, Military Medical Academy, University Clinical Center Novi Sad, University Clinical Center Niš, and General Hospital Užice. Results. From 2012 to 2018, in six hospitals in Serbia, data for 342 procedures on treating PAA were collected for 329 (96.2%) men and only 13 (3.8%) women. The incidence of PAA repair was 6.8 operations per million inhabitants a year. The mean age of patients was 64.34 years (ranging from 29 to 87). A total of 223 (65.8%) elective procedures were performed. Amputation and hospital survival were considered the main outcomes. Thrombosis was recorded in 110 (32.5%) patients as a cause for surgery, and rupture was recorded in 5 patients. The mean diameter of the aneurysm was 35.3 mm, and a slightly larger diameter was recorded in ruptured aneurysms – 43.8 mm on average. Both synthetic and vein grafts were used in elective and urgent procedures equally. Endovascular procedures were performed in 6 (1.8%) cases. Conclusion. This study confirms the importance of registry-based collection of data and their analysis. It showed that the national incidence of PAA in Serbia is low and that well-organized, even institution-based, screening algorithms should improve identifying such patients and increase the number of electively treated PAA. Educating vascular surgeons to use the posterior approach could improve vascular healthcare.

References

1. Serrano Hernando FJ, Martínez López I, Hernández Mateo MM, Hernando Rydings M, Sánchez Hervás L, Rial Horcajo R, et al. Comparison of popliteal artery aneurysm therapies. J Vasc Surg 2015; 61(3): 655–61.

2. Grip O, Mani K, Altreuther M, Bastos Gonçalves F, Beiles B, Cassar K, et al. Contemporary Treatment of Popliteal Artery Aneurysms in 14 Countries: A Vascunet Report. Eur J Vasc Endovasc Surg 2020; 60(5): 721–9.

3. Ghotbi R, Deilmann K. Popliteal artery aneurysm: surgical and endovascular therapy. Chirurg 2013; 84(3): 243–54. (German)

4. Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2020; 59(2): 173–218.

5. Cervin A, Ravn H, Björck M. Ruptured popliteal artery aneurysm. Br J Surg 2018; 105(13): 1753–8.

6. Akman J, Katsogridakis E, Antoniou GA. Ruptured popliteal artery aneurysms. Vascular 2019; 27(4): 430–47.

7. Tomić A. Kompartment sindrom. Belgrade: Pharmanova; 2010. (Serbian)

8. Davidovic L, Jakovljevic N, Radak D, Dragas M, Ilic N, Koncar I, et al. Dacron or ePTFE graft for above-knee femoropopliteal bypass reconstruction. A bi-centre randomised study. Vasa 2010; 39(1): 77–84.

9. Kainth A, Smeds MR. Popliteal Aneurysm Repair. Treasure Island (FL): StatPearls Publishing; 2022.

10. Kropman RH, van Santvoort HC, Teijink J, van de Pavoordt HD, Belgers HJ, Moll FL, et al. The medial versus the posterior approach in the repair of popliteal artery aneurysms: a multicenter case-matched study. J Vasc Surg 2007; 46(1): 24–30.

11. Dragas M, Zlatanovic P, Koncar I, Ilic N, Radmili O, Savic N, et al. Effect of Intra-operative Intra-arterial Thrombolysis on Long Term Clinical Outcomes in Patients with Acute Popliteal Artery Aneurysm Thrombosis. Eur J Vasc Endovasc Surg 2020; 59(2): 255–64.

12. Joshi D, Gupta Y, Ganai B, Mortensen C. Endovascular versus open repair of asymptomatic popliteal artery aneurysm. Cochrane Database Syst Rev 2019; 12(12): CD010149.

13. Zamboni M, Scrivere P, Silvestri A, Vit A, Pellegrin A, Sponza M, et al. Hybrid Approach to Popliteal Artery Aneurysm with Thromboembolic Symptoms. A Pilot Study. Ann Vasc Surg 2021; 72: 270–5.

14. Dorigo W, Pulli R, Turini F, Pratesi G, Credi G, Innocenti AA, et al. Acute leg ischaemia from thrombosed popliteal artery aneurysms: role of preoperative thrombolysis. Eur J Vasc Endovasc Surg 2002; 23(3): 251–4.

15. Ohrlander T, Holst J, Malina M. Emergency intervention for thrombosed popliteal artery aneurysm: can the limb be salvaged? J Cardiovasc Surg (Torino) 2007; 48(3): 289–97.

16. Behrendt CA, Bertges D, Eldrup N, Beck AW, Mani K, Venermo M, et al. International Consortium of Vascular Registries Consensus Recommendations for Peripheral Revascularisation Registry Data Collection. Eur J Vasc Endovasc Surg 2018; 56(2): 217–37.

17. Behrendt CA, Björck M, Schwaneberg T, Debus ES, Cronenwett J, Sigvant B. Acute Limb Ischaemia Collaborators. Editor's Choice - Recommendations for Registry Data Collection for Revascularisations of Acute Limb Ischaemia: A Delphi Consensus from the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2019; 57(6): 816–21.

18. Björck M, Beiles B, Menyhei G, Thomson I, Wigger P, Venermo M, et al. Editor's Choice: Contemporary treatment of popliteal artery aneurysm in eight countries: A Report from the Vascunet collaboration of registries. Eur J Vasc Endovasc Surg 2014; 47(2): 164–71.

19. Earnshaw JJ. Where We Have Come From: A Short History of Surgery for Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2020; 59(2): 169–70.

20. Galland RB. Popliteal aneurysms: from John Hunter to the 21st century. Ann R Coll Surg Engl 2007; 89(5): 466–71.

21. Schwarze V, Marschner C, de Figueiredo GN, Rübenthaler J, Clevert DA. Contrast-enhanced ultrasound (CEUS) in the diagnostic evaluation of popliteal artery aneurysms, a single-center study. Clin Hemorheol Microcirc 2020; 76(2): 191–7.

22. Piccoli G, Gasparini D, Smania S, Sponza M, Marzio A, Vit A, et al. Multislice CT angiography in the assessment of peripheral aneurysms. Radiol Med 2003; 106(5–6): 504–11. (English, Italian)