Endovascular Repair of Popliteal Artery Aneurysms: Techniques, Current Evidence and Recent Experience

Abstract

Endovascular repair of popliteal artery aneurysms is a new technique, which has emerged as an alternative to open surgical bypass. However, evidence to support its use is limited. We present a review of current literature relevant to this technique. The MEDLINE search terms were popliteal artery, aneurysm, endovascular, endoluminal and stent. Fifty-eight articles were yielded, of which 21 were studies of endovascular repair by implantation of stent or stent graft of true aneurysms of the popliteal artery. There was only one randomized study. Small numbers of endovascular interventions are reported, with variations in study design and endovascular techniques. Long-term follow-up data is lacking; however, early results have been promising with high rates of initial treatment success. Early thrombosis of stent grafts occurs in approximately 10%, but this does not herald limb loss. Endovascular treatment offers potential benefits over traditional surgery, but needs to be studied further with a large-scale multicentre randomized trial.

Endovascular Exclusion of Popliteal Artery Aneurysms With Stent-Grafts: A Prospective Single-Center Experience

“…5,26,30 In contrast, percutaneous endovascular repair has several potential advantages, including decreased blood loss, infection, and hospitalization, as well as decreased mortality in patients who have significant comorbidities and cannot tolerate general anesthesia. 5,6,18,26,27,30–38 Endovascular repair also allows subsequent intervention via a percutaneous or surgical approach. Percutaneous endovascular repair of PAAs has been limited by stent deformation and subsequent occlusion, but improved patency rates have been observed in patients treated with stent-grafts.…”

Acute Compartment Syndrome Related to Stent-Graft Exclusion of a Popliteal Arterial Aneurysm

“…Stent grafting for popliteal aneurysms is gaining acceptance in the United States, and the Viabahn stent graft is currently one of the most popular devices. 1,2 Although the current case clinically turned out very well, two key points warrant discussion. The first is the bowstring effect during deployment of the Viabahn stent graft.…”

Two Decades of Endovascular Repair of Popliteal Artery Aneurysm—A Meta-analysis

“…34 Therefore, common complications of EVR are stent graft thrombosis, migration, kinking, fractures, and the occurrence of endoleaks. 35,36 In 2010, Midy et al presented higher complication rates after the use of Wallgraft stent grafts (Boston Scientific, Natick, MA, USA) than with Viabahn (Gore) stent grafts in PAA. 10 Apparently, owing to reduced flexibility, Wallgraft stent grafts occluded more easily and were associated with more endoleaks.…”

“…For a successful stent graft implantation, patients with at least two runoff vessels and suitable proximal and distal landing zones (2 cm) are preferred. 35,39 Despite gaining wide acceptance of EVR for PAA and its acceptable results, the US Food and Drug Administration has not yet approved this technique. As a consequence, many vascular surgeons, even outside the USA, are reluctant to use EVR, especially in younger patients with acute symptoms.…”