Endovascular Treatment of Popliteal Artery Aneurysms: A Word of Caution after Long-Term Follow-up.

BACKGROUND: The aim of this work was to evaluate the long-term patency of endografting in the treatment of popliteal artery aneurysms (PAAs) and to identify which factors may be predictors of graft occlusion. METHODS: All the patients who underwent endovascular repair of PAA were analyzed from 2006 until 2014 on the basis of symptoms, comorbidities, limb salvage, and long-term patency. The predictive value of the different variables was assessed in univariate analysis for primary patency and, for factors resulted significant, a multivariate analysis was performed. The Kaplan-Meier life table method was used to calculate patency and limb salvage. RESULTS: We treated 65 PAAs in 57 patients (53 men and 4 women). PAAs were symptomatic in 26 cases (40%) and 34% were the emergency cases; the mean aneurysm size was 33.8 ± 17 mm. Mean follow-up was 35 months ± 25. Graft occlusion occurred in 22 limbs (35%). We had 9 amputations (14.5%). The late conversion to open surgery was 6.4%. The cumulative estimated 60-month primary patency, secondary patency, and limb salvage were respectively 57% (standard error [SE] ±0.7), 73% (SE ±0.7), and 83% (SE ±0.5). We found that diabetes (hazard ratio [HR] 2.936, 95% confidence interval [CI] 0.993-8.683), associated percutaneous transluminal angioplasty (PTA) procedures (HR 2.534, 95% CI 1.115-5.757), symptoms (HR 2.492, 95% CI 1.127-5.510), and runoff scores (HR 2.069, 95% CI 0.942-4.544) were the most important risk factors for long-term patency at univariate analysis. When considering a multivariate analysis symptoms (HR 2.066, 95% CI 0.862-4.952) become the principal risk factor followed by diabetes (HR 1.808, 95% CI 0.531-6.157)], runoff scores (HR 1.716, 95% CI 0.757-3.893) and associated PTA procedures (HR 1.441, 95% CI 0.519-3.839), but no one reached a statistical significance. CONCLUSIONS: On the base of our experience it seems that several factors affect durability in PAA endovascular repair, especially the presence of acute symptoms, diabetes, and runoff. Therefore until further refined clinical studies, we believe that the actual role of this technique must be yet clarified.

Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication.

BACKGROUND: Tension hemothorax is a rare event, due to different causes: trauma, ruptured thoracic aorta aneurysms, or as a complication of central venous line placement due to inadvertent artery puncture or cannulation. Tension hemothorax leads to both hypovolemic and obstructive shock and can require emergency management. PRESENTATION OF CASE: A 63 years old lady underwent a complicated surgical procedure for a postoperative small bowel obstruction after radical cystectomy. During the procedure, a central venous catheter was placed, under ultrasound guidance, in the right jugular vein but an unknown puncture of the right subclavian artery occurred. In the early phase of the postoperative course, a hypovolemic/obstructive shock developed because of a tension hemothorax. The patient underwent an emergency thoracotomy in the hybrid room, followed by an endovascular repair of the arterial laceration. A recurrent hemothorax developed a few hours later because of an endoleak that was treated successfully with a second endovascular approach and a balloon dilatation of the stent. CONCLUSIONS: tension hemothorax due to inadvertent subclavian artery laceration can be life-threatening and should be managed in a hybrid room with endovascular and surgical capabilities.