Contemporary Outcomes of Short Medial Bypass for the Treatment of Popliteal Artery Aneurysms

Abstract

Background

Popliteal artery aneurysms are the most common peripheral artery aneurysms, treated by endovascular stenting or open surgical repair by bypass. Short medial bypass is the predominant open surgical repair; however published outcomes frequently combine all techniques (medial and posterior, short and long, vein and prosthetic), preventing accurate interpretation of technique-specific results.

Methods

We present a retrospective cohort study of across 2 UK tertiary centres between January 2014 and December 2019. All patients underwent short exclusion bypass with autologous saphenous vein only. Short bypass was defined as inflow from mid-distal superficial femoral artery or above-knee popliteal artery to outflow at below-knee popliteal artery, tibioperoneal trunk, or crural vessel.

Results

69 limbs in 59 patients underwent short bypass over this period. Median age was 71 years, 96% were male and a PAA median size of 35 mm. Five-year outcomes demonstrated overall survival of 83.1% (95% CI: 74.0 – 93.2%), amputation-free survival of 76.3% (95% CI: 66.2 – 87.9%), and secondary patency of 90.1% (95% CI: 82.9 – 98.0%). Thirty percent required reintervention, predominantly for graft stenosis or ongoing sac perfusion. There was no evidence of proximal inflow disease progression that required intervention.

Conclusions

Short medial bypass requires reintervention in 1 in 3 patients within 5 years for sac perfusion or graft stenosis but achieves excellent secondary patency.