Endovascular treatment of popliteal artery aneurysm: preliminary results Poster No.: C-0483 Congress: ECR 2012 Type: Scientific Paper Authors: G. Guzzardi, R. Fossaceca, P. Cerini, C. Stanca, I. Di Gesù, F. Martino, A. Carriero; Novara/IT Keywords: DOI: Vascular, Interventional vascular, Cardiovascular system, Catheter arteriography, Percutaneous, Ultrasound-Colour Doppler, Stents, Angioplasty, Aneurysms 10.1594/ecr2012/C-0483 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Purpose Popliteal artery aneurysm (PAA) is the most common form of peripheral arterial aneurysm although is a rare condition with an incidence < 0.1%. Thrombus formation and possible embolization as a result of PAA may reduce blood flow, leading to limb threatening ischemia and potential limb amputation. Symptomatic patients and asymptomatic with PAA larger than 2 cm, should be treated. The standard therapy is currently represented by open surgery with placement of autologous vein or prosthetic by-pass through medial or posterior limb incision, depending on the proximal and distal extension of the aneurysm. Endovascular approaches currently offer several advantages including a minimally invasive approach, fewer perioperative complications and a faster recovery. The aim of this study was to evaluate the effectiveness of endovascular treatment of PAA with covered self-expanding stents. Methods and Materials From January 2009 to July 2010 10 patients (9 men and 1 woman, mean age 69 +/- 12years) with PAA were treated with covered self-expanding stents (Viabahn (WL Gore & Associated, Inc., Flagstaff, AZ, USA) (Table 1). We evaluated the procedural technical success, patency at 1, 6 and 12 months using Doppler color-flow, the associated complications, the duration of the procedure and the postoperative hospital stay. Images for this section: Page 2 of 7
Fig. 4: Table 1. Characteristics of patients and aneurysms treated. Page 3 of 7
Results We had a 100% technical success, without any periprocedural complications. The average duration of the procedure was 40 minutes, the average hospital stay was 3 days. We observed one acute thrombosis of the stent at 6 months; the patient was treated with loco-regional thrombolytic therapy and PTA of a trunk tibio-peroneal stenosis. The primary and secondary patency were respectively 95% and 100% with mean follow-up of 12 months (7-20 months). Only one case (10%) of endoleaks has been observed. Images for this section: Fig. 1: The angiography shows a case of supraarticular popliteal artery aneurysm treated with self-expanding stent positioning. Page 4 of 7
Fig. 2: Figure 1. Endovascular treatment of PAA. CT-angiography scan documents the presence of partially trombozed popliteal aneurysm with maximum diameter of 2.3 cm. The preliminary angiography confirms this finding: the aneurysm has been successfully treated by Viabahn stent-graft placement. Fig. 3: Figure 2. Endovascular treatment of retro-geniculate PAA. Preliminary angiography shows the presence of popliteal artery aneurysms in the retro-geniculate tract treated by Viabahn stent-graft. Page 5 of 7
Conclusion Endovascular repair for PAA with suitable anatomy and good tibial run-off, is a feasible, safe and effective alternative to open surgical repair, although, longterm patency rates have not yet been delineated. Our study, according to literature data, documents the effectiveness of endovascular repair of PAA, with short and mid term patency comparable to open surgery. A randomized, controlled trial is necessary to define the true role of this new modality of treatment for PAA. References 1. Wolf YG, Kobzantsev Z, Zelmanovich L (2006) Size of normal and aneurysmal popliteal arteries: a duplex ultrasound study. J Vasc Surg 43: 488-492 2. Trickett JP, Scott RA, Tilney HS (2002) Screening and management of asymptomatic popliteal aneurysms. J Med Screen 9: 92-93 3. Dawson I, Sie RB, van Bockel JH (1997) Atherosclerotic popliteal aneurysm. Br J Surg 84: 293-299. 4. Henke PK (2005) Popliteal artery aneurysms: tried, true, and new approaches to therapy. Semin Vasc Surg 18: 224-230 5. Diwan A, Sarkar R, Stanley JC, et al (2000) Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg 31:863-869 6. Davies RSM, Wall M, Rai E et al. (2007) Long term results of surgical repair of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 34: 714-718 7. Lovegrove RE, Javid M, Magee TR, Galland RB (2008) Endovascular and open approaches to non-thrombosed popliteal aneurysm repair: a meta analysis. Eur J Vasc Endovasc Surg 36: 96-100 8. Tielliu IF, Verhoeven EL, Zeebregts CJ, et al. (2007) Endovascular treatment of popliteal artery aneurysms: is the technique a valid alternative to open surgery? J Cardiovasc Surg (Torino) 48: 275-279 9. Antonello M, Frigatti P, Battocchio P, et al. (2007) Endovascular treatment of asymptomatic popliteal aneurysms: 8-year concurrent comparison with open repair. J Cardiovasc Surg (Torino) 48:267-274 Page 6 of 7
10. Jung E, Jim J, Rubin BG, Sanchez LA, Choi ET, Sicard GA, Geraghty PJ (2010) Long-term outcome of endovascular popliteal artery aneurysm repair. Ann Vasc Surg 24: 871-875 11. Cina C (2010) Endovascular repair of popliteal aneurysm. J Vasc Surg 51:1056-1060 12. Etezadi V, Fuller J, Wong S, et al. (2010) Endovascular treatment of popliteal artery aneurysms: a single-centre experience. J Vasc Interv Radiol 21:817-823 13. Midy D, Bernard X, Ferdani M et al. (2010) A retrospective multicenter study of endovascular treatment of popliteal artery aneurysm. J Vasc Surg 51:850-856 14. Mohan IV, Bray PJ, Harris JP et al. (2006) Endovascular popliteal aneurysm repair: are the results comparable to open surgery? Eur J Vasc Endovasc Surg 32:149-154 15. Moore RD, Hill AB J (2010) Open versus endovascular repair of popliteal artery aneurysms J Vasc Surg 51:271-276 Personal Information Page 7 of 7