Endovascular treatment of popliteal artery aneurysms

Popliteal artery aneurysms treatments: early midterm results of the use of endovascular stent grafts

Background/aim

Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data.

Material and methods

A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel tortuosity, the presence and degree of thrombus, and diameter in the healthy landing zone and to visualize tibioperoneal vascular structures. A Viabahn stent graft was inserted in all patients.

Results

57 patients (90.5%) were males with a mean age of 76.35 ± 7 years. 24 patients (38.1%) were symptomatic, while 11 patients (17.5%) had a concomitant abdominal aortic aneurysm (AAA). The mean follow-up period was 46.05 ± 25.01 months. The primary patency rate was 79.3%. A graft thrombosis was observed in 13 patients (20.6%) during a mean follow-up period of 8.31 ± 5.91 months. The number of distal arteries was significantly lower in the patients with thrombosis than those without.

Conclusions

Endovascular treatment of PAA using stentgrafts is safe in selected cases. However, it is reasonable to avoid endovascular treatment due to an increased risk for thrombosis in patients with a low number of patent distal arteries or impaired distal flow.

Retrograde stent-graft angioplasty of superficial femoral artery occlusion in a claudicant

Endovascular therapy has become an accepted mode of therapy for lifestyle-limiting claudication, especially if the disease is confined to the superficial femoral artery (SFA). The standard approach to these lesions is from the contralateral femoral artery and crossing over the aortic bifurcation. In patients who have an aortobifemoral bypass (AFB), this technique is usually not feasible secondary to the angles of the graft. The authors report on their approach to a 60-year-old man with lifestyle-limiting claudication and SFA disease, and an AFB in place. They performed a retrograde approach to the SFA via a small above-knee popliteal artery exposure. They used the recently approved (in the United States) heparin-bonded VIABAHN for the revascularization via this approach, which would have allowed them to proceed to an open bypass procedure if they were unsuccessful in the same setting.