Great saphenous vein versus expanded polytetrafluoroethylene graft in patients undergoing elective treatment of popliteal artery aneurysm with a posterior approach

Abstract

Background: The aim of this study was to compare 30-day and 5-year outcomes of great saphenous vein (GSV) vs expanded polytetrafluoroethylene (ePTFE) graft in patients undergoing elective treatment of popliteal artery aneurysm (PAA) using a posterior approach.

Methods: Between January 2010 and December 2023, a retrospectively maintained dataset of all consecutive asymptomatic PAAs who underwent open repair with posterior approach or endovascular repair in 40 centers was investigated. Of 971 cases, 525 patients were included in the present analysis. These were further divided into posterior approach with GSV graft (252; GSV group), and posterior approach with ePTFE graft (273; ePTFE group). Thirty-day outcomes were assessed and compared. During follow-up, survival, primary patency, secondary patency, freedom from reintervention(s), and amputation-free survival rates were compared between the two groups using log-rank tests. Univariate and multivariate Cox regression analyses were performed in the ePTFE group to find predictive factors of poor outcomes.

Results: Two groups were homogeneous in terms of preoperative risk factors and morphological data. Median follow-up duration was similar (24 months [interquartile range [IQR], 10-36 months] GSV group vs 21 months [IQR, 7-47 months] ePTFE group; P = .123). At 5 years, there were no differences between the two groups in terms of survival (84.7% GSV group vs 86.1% ePTFE group; P = .097, log-rank = 2.756), secondary patency (94.9% GSV group vs 89.4% ePTFE group; P = .068, log-rank = 3.336), or amputation-free survival (99.1% GSV group vs 99.6% ePTFE group; P = .567, log-rank = .328). Five-year primary patency (89.5% GSV group vs 76.2% ePTFE group; P = .007, log-rank = 7.239) and freedom from reintervention(s) (92.8% GSV group vs 80.6% ePTFE group; P = .011, log-rank = 6.449) were significantly higher in the GSV group. Using multivariate analysis in the ePTFE group, factors compromising primary patency were patients on dialysis (P = .054; odds ratio, 3.641), and patients who were not on any preoperative antiplatelet therapy or anticoagulation (P = .019; odds ratio, 5.532), whereas none of the perioperative factors affected freedom from reintervention(s).

Conclusions: GSV as graft guaranteed better primary patency with lower reinterventions rates at midterm follow-up after treatment of PAAs via a posterior approach. Patients on dialysis and who were not on any preoperative antiplatelet therapy or anticoagulation had lower patency rates.

Keywords: Expanded polytetrafluoroethylene; Great saphenous vein; Popliteal artery aneurysm; Posterior approach.