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December 23, 2005
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Hiranya A. Rajasinghe, MD, Argyrios Tzilinis, MD, Theresa Keller, RN, Jeff Schaeffer, RVT.
Anchor Health Centers/Naples Community Hospital, Naples, FL, USA.
Background:
Standard interposition surgical bypass exclusion of aymptomatic popliteal artery aneurysms is restricted to good risk surgical patients with satisfactory autogenous vein to prevent limb threatening ischemic complications.
Purpose:
We examined the use of a flexible PTFE covered nitinol stent, Viabahn WL Gore, for the endovascular exclusion of asymptomatic popliteal artery aneurysms in high risk surgical patients.
Methods:
12 male patients with a mean age of 76 (range 65 - 83) underwent endovascular treatment of 16 asymptomatic popliteal artery aneurysms with a mean diameter of 2.50 cm (range 1.5 - 4.8 cm). 6/16 aneurysms had partial thrombus identified by pre-procedural duplex imaging. 12 of 16 limbs treated had at least 2 vessel runoff. All procedures were performed by a single operator under local anesthesia using an antegrade percutaneous puncture technique.
Results:
100% technical success was achieved in all cases with complete aneurysm exclusion and all patients were discharged home ambulatory within 24 hours. No cases of partial or complete graft thrombosis occurred within the first 30 days following endovascular popliteal artery aneurysm exclusion . Post procedure anticoagulation consisted of single daily dose clopidogrel. Follow-up was conducted by direct clinical exam with duplex imaging of the treated popliteal segment in flexion. At a mean follow-up of 6.7 months (range 1 - 18 months), 15 of 16 patients have remained asymptomatic. Duplex follow-up demonstrated a mean ABI = 1.0 (range 0.82 - 1.31) in 15 of 16 patent stent grafts with preserved tibial vessel runoff. A single stent graft thrombosis occurred at 6 month follow-up treated with percutaneuous mechanical thrombectomy, balloon angioplasty, and an additional stent insertion. No popliteal artery aneurysm size enlargement has been observed following endovascular exclusion.
Conclusions:
Results with endovascular exclusion of asymptomatic popliteal artery aneurysms compare favorably with standard surgical therapy in early follow-up particularly in high risk patients. PTFE covered nitinol stents grafts appear to be well suited for popliteal artery aneurysm exclusion because of their flexibility and rotational conformability. Close surveillance will be required to expand the indications for popliteal artery aneurysm exclusion; however, strict attention may need to be paid to the quality of the tibial vessel runoff to predict patient selection.
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Endovascular Exclusion Of Popliteal Artery Aneurysms With Covered PTFE Stent Grafts: Early Results
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Hiranya A. Rajasinghe, MD, Argyrios Tzilinis, MD, Theresa Keller, RN, Jeff Schaeffer, RVT.
Anchor Health Centers/Naples Community Hospital, Naples, FL, USA.
Background:
Standard interposition surgical bypass exclusion of aymptomatic popliteal artery aneurysms is restricted to good risk surgical patients with satisfactory autogenous vein to prevent limb threatening ischemic complications.
Purpose:
We examined the use of a flexible PTFE covered nitinol stent, Viabahn WL Gore, for the endovascular exclusion of asymptomatic popliteal artery aneurysms in high risk surgical patients.
Methods:
12 male patients with a mean age of 76 (range 65 - 83) underwent endovascular treatment of 16 asymptomatic popliteal artery aneurysms with a mean diameter of 2.50 cm (range 1.5 - 4.8 cm). 6/16 aneurysms had partial thrombus identified by pre-procedural duplex imaging. 12 of 16 limbs treated had at least 2 vessel runoff. All procedures were performed by a single operator under local anesthesia using an antegrade percutaneous puncture technique.
Results:
100% technical success was achieved in all cases with complete aneurysm exclusion and all patients were discharged home ambulatory within 24 hours. No cases of partial or complete graft thrombosis occurred within the first 30 days following endovascular popliteal artery aneurysm exclusion . Post procedure anticoagulation consisted of single daily dose clopidogrel. Follow-up was conducted by direct clinical exam with duplex imaging of the treated popliteal segment in flexion. At a mean follow-up of 6.7 months (range 1 - 18 months), 15 of 16 patients have remained asymptomatic. Duplex follow-up demonstrated a mean ABI = 1.0 (range 0.82 - 1.31) in 15 of 16 patent stent grafts with preserved tibial vessel runoff. A single stent graft thrombosis occurred at 6 month follow-up treated with percutaneuous mechanical thrombectomy, balloon angioplasty, and an additional stent insertion. No popliteal artery aneurysm size enlargement has been observed following endovascular exclusion.
Conclusions:
Results with endovascular exclusion of asymptomatic popliteal artery aneurysms compare favorably with standard surgical therapy in early follow-up particularly in high risk patients. PTFE covered nitinol stents grafts appear to be well suited for popliteal artery aneurysm exclusion because of their flexibility and rotational conformability. Close surveillance will be required to expand the indications for popliteal artery aneurysm exclusion; however, strict attention may need to be paid to the quality of the tibial vessel runoff to predict patient selection.
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