RR5. Surgical Treatment of Popliteal Aneurysms Using a Posterior Approach: Thirteen Years' Follow-up

OBJECTIVES : Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years\u2019 period. METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis. RESULTS : A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years). Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9\ub11 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%. One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months). Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%\ub18,7% and 96.4%\ub13.5% respectively for PA, and 67.4%\ub110,4% and 81.3%\ub18,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%\ub16.4% at 5 and 10 years respectively for PA and 91.5%\ub15.6% at both time points for MA (p=0.3). CONCLUSIONS : PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA. AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose

Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients

OBJECTIVE: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery-identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. METHODS: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its β coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. RESULTS: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7% ± 1.7% vs 85.2% ± 2% (P = .41). Group-specific 5-year survival within the DC was 97% ± 1.5% (group 1), 88.4% ± 2.2% (group 2), 69.6% ± 4.7% (group 3), and 48.1% ± 13.5% (group 4; P < .0001). Five-year survival within the VC was 95.5% ± 2% (group 1), 89.5% ± 2.7% (group 2), 65% ± 6.1% (group 3), and 44.8% ± 14.1% (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. CONCLUSIONS: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure