A retrospective multicenter study of endovascular treatment of popliteal artery aneurysm.

PURPOSE: To evaluate the feasibility of endovascular exclusion of popliteal artery aneurysm (PAA) using stent grafts. METHODS: The clinical data of all patients who underwent endovascular exclusion of PAA at three French vascular departments between December 1999 and December 2007 were retrospectively analyzed. Outcome measures included graft patency and endoleak. The Kaplan-Meier method was used to calculate the primary and secondary patency curves. RESULTS: A total of 57 PAA in 50 patients (48 men; mean age, 72 +/- 11 years; range, 57-96 years) were treated. The type of stent graft used was Hemobahn/Viabahn in 42 (73.7%) cases, Wallgraft in 14 (24.5%) and Passager in one. The mean duration of hospitalization was 5 +/- 1.8 days (range, 3-11 days). No patients were lost from follow up (mean, 36 +/- 19.4 months; range, 6-96 months). Nine (16%) occlusions and six (10.5%) endoleaks occurred. The global limb salvage rate was 96.5% (55 of 57 PAA). Kaplan-Meier estimates for primary and secondary patency were 85.8% and 87.5% at one year and 82.3% and 87.5% at three years. CONCLUSIONS: Endovascular treatment of PAA is feasible in selected patients. The main determinants of success are suitable aneurysm anatomy and dual antiplatelet postoperative therapy. Further studies are warranted to determine long-term outcomes of endovascular repair for PAA.

Value of cutting balloon angioplasty for limb salvage in patients with obstruction of popliteal and distal arteries.

Popliteal-to-distal bypass is still the gold standard for limb salvage. However, some patients, especially elderly or diabetic patients, are not eligible for such treatment; and problems may arise, including poor healing of distal surgical wounds, delayed resumption of ambulation, and prolonged hospitalization. This prospective multicenter study carried out on an intent-to-treat basis includes 53 extremities in 48 patients presenting critical ischemia due to infrageniculate arterial lesions with no proximal lesions. Two populations were isolated: diabetic patients (56.6%) and elderly patients over 80 years (45%). In 82% of cases the arterial lesions were long, i.e., more than 1 cm. The limb salvage rate at 1 year was 81%. Postoperative mortality was 9%, and mortality at 1 year was 22.6%. These results show that cutting balloon angioplasty can be proposed as primary treatment in patients with critical ischemia due to popliteal and distal artery lesions.

Thoracic endograft positioning and carotid-subclavian bypass grafting in a patient with a saccular aneurysm at the aortic arch.

A 75-year-old man was referred to our hospital because of sudden thoracic pain. A saccular aneurysm of the aortic arch extending on the anterior surface of the aortic arch was found on computed tomographic arteriography. The patient was hemodynamically stable and he was programmed for a staged surgical and endovascular approach (hybrid approach). As a first stage and in order to prevent major cardiac complications due to the overstenting of the left subclavian artery (LSA) with the occlusion of the aortocoronary bypass, the patient underwent a polytetrafluoroethylene bypass graft (GORE-TEX, W.L. Gore & Associates, Flagstaff, AZ) between the LSA and the left carotid artery. Intraoperative arteriography revealed a good patency of the left carotid-subclavian bypass and of the left internal mammary bypass on the left anterior descending artery. As a second stage the endovascular procedure was accomplished 5 days later in the operating room. A Gore TAG stent graft (W.L. Gore & Associates) was deployed in the aortic arch 20 mm proximally to the aneurysmatic segment covering the ostium of the LSA. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day in good general conditions. Hybrid procedures for treatment of aneurysms of the aortic arch or of the descending thoracic aorta are a promising alternative to open surgery especially in high-risk patients, with lower early morbidity and mortality rates. Long-term effectiveness remains to be fully elucidated.