Posterior Approach Popliteal Artery Endarterectomy for the Treatment of Peripheral Arterial Disease
David Fredenburg, MD, Joseph D. Ayers, MD.
Bassett Medical Center, Cooperstown, NY, USA.
Objective: Isolated occlusion or high grade stenosis of the popliteal artery causing limb ischemia often presents a treatment dilemma. Due to its position behind the knee the popliteal artery is subject to significant torsional forces which may limit the durability of endovascular procedures. Bypass to the distal popliteal or tibial vessels can be a durable and effective procedure but may be morbid and leaves few options if it fails. Popliteal endarterectomy with patch angioplasty from the posterior approach does not use venous conduit or alter targets for future bypass and provides an excellent access site for hybrid endovascular procedures. The purpose of this study is to review our experience with posterior approach popliteal endarterectomy in order to assess durability and patient outcomes.
Methods: Patients who underwent popliteal endarterectomy from a posterior approach with or without adjunctive procedures at a single institution over a seven year period were retrospectively reviewed. Repairs were assessed post operatively for patency in vascular lab. Patients were also assessed post operatively for change in Rutherford chronic limb ischemia scale and improvements in quality of life.
Results: Eleven patients underwent posterior approach popliteal endarterectomy. The surgical indication was rest pain in three patients, claudication in five patients and tissue loss in three patients. Four patients underwent prior endovascular procedures and one patient had a failed prior bypass. The endarterectomy was successfully completed in all of the cases. Complications included two wound infections, one early thrombosis, one late re-stenosis, and one popliteal vein thrombosis. Average pre- and post- operative ABIs were 0.60 and 1.03 respectively, an increase of 0.41 with one patient having non-compressible vessels. Average Rutherford chronic ischemia scale decreased from 3.8 to 1.1. All patients had patent repairs at an average of 18 months of follow up. All patients described significant increase in quality of life after surgery.
Conclusions: This study has the largest patient cohort we know of to date who have undergone popliteal endarterectomy from a posterior approach for limb ischemia. This study demonstrates the surgery is safe, effective and durable while not limiting options for later bypass or endovascular procedures. Posterior approach popliteal endarterectomy also lends itself to possible endovascular hybrid procedures, which we plan to investigate in the future.
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