Clinical Outcome of Isolated Popliteal Artery Aneurysms Treated with a Heparin-bonded Stent Graft.

OBJECTIVE: The use of self-expanding stent grafts for treatment of popliteal artery aneurysms (PAA) is a matter of debate, although several studies have shown similar results compared with open surgery. In recent years, a new generation stent graft, with heparin-bonding technology, became available. The aim of this study is to present the results of endovascular PAA repair with heparin-bonded stent grafts. METHODS: Data on all patients with PAA treated with a heparin-bonded polytetrafluoroethylene (ePTFE) stent graft between April 2009 and March 2014 were gathered in a database and retrospectively analyzed. Data were collected from four participating hospitals. Standard follow-up consisted of clinical assessment, and duplex ultrasound at 6 weeks, 6 months, 12 months, and annually thereafter. The primary endpoint of the study was primary patency. Secondary endpoints were primary-assisted and secondary patency and limb salvage rate. RESULTS: A total of 72 PAA was treated in 70 patients. Mean age was 71.2 ± 8.5 years and 93% were male (n = 65). The majority of PAA were asymptomatic (78%). Sixteen cases (22%) had a symptomatic PAA, of which seven (44%) presented with acute ischemia. Early postoperative complications occurred in two patients (3%). Median follow-up was 13 months (range 0-63 months). Primary patency rate at 1 year was 83% and after 3 years 69%; primary assisted patency rate was 87% at 1 year and 74% after 3 years. Secondary patency rate was 88% and 76% at 1 and 3 years, respectively. There were no amputations during follow-up. CONCLUSION: Endovascular treatment of PAA with heparin-bonded stent grafts is a safe treatment option with good early and mid-term patency rates comparable with open repair using the great saphenous vein.

The role of superficial femoral artery endoluminal bypass in long de novo lesions and in-stent restenosis.

AIM: Results of endovascular treatment for long de novo lesions of the superficial femoral artery (SFA) are limited by in-stent restenosis (ISR). Polytetrafluoroethylene (PTFE) covered stents are developed to reduce the incidence of ISR. This study was conducted to summarize available data on the use of endoprosthesis in the treatment of SFA occlusive disease and to evaluate their use in the treatment of ISR. METHODS: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. Reports on the application of Hemobahn® and Viabahn® endoprosthesis in the treatment of long de-novo lesions and ISR of the SFA were included. RESULTS: A total of 19 articles were included. Technical success rates varied between 95-100%. Case series have shown 1-year primary patency rates varying between 44% and 86%, with secondary patency rates between 58% and 93%. Large differences in patient and lesion characteristics, medical therapy and developments in stent-graft design complicate comparisons between studies. Randomized studies have shown a superiority of the endoprosthesis above angioplasty only and similar patency rates with above-knee prosthetic femoro-popliteal bypass up to 48 months. Data on the use of endografts for ISR are scarce. CONCLUSION: The use of an endoprosthesis for SFA occlusive disease is an effective and safe treatment strategy for long de novo lesions. Patient selection and adequate medical support appear to be important in achieving long term patency. Data focusing on the effectiveness of endoprosthesis for ISR are still limited.