Popliteal Artery Aneurysms: Is Endovascular Reconstruction Durable?

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This initial series describes a minimally invasive, endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization. Twenty patients have undergone PAA operations. Eleven patients had conventional SV bypasses with proximal and distal ligation of the popliteal artery (PA), and nine patients underwent PAA embolization and an endovascular in situ SV bypass (EISB). The EISB bypass was performed using an angioscopic guided side branch occlusion coil system, whereas the PAAs were embolized with occlusion coils under fluoroscopic surveillance. After operation in the EISB group there were no deaths, no wound complications, and the mean hospital length of stay (LOS) was 2.1 days. Six operations were performed through two incisions, and three operations required an additional incision. Primary patency was 88% (8/9), and all PAAs remained occluded by color flow ultrasonography at follow-up ranging from 4 to 23 months (mean 11.2 months). In the conventional bypass group there were no deaths, three patients (27%) had wound complications, and the mean LOS was 6.2 days. Bypass patency at 42 months was 91% (10/11). This minimally invasive combined radiological and endovascular surgical technique obviates an extensive incision to harvest the SV and ligate the PAA proximally and distally. If long-term endovascular bypass graft patency and PAA occlusion rates prove to be similar to open operative results, the benefits of reduced wound complications, decreased hospital LOS, and increased health care savings support further investigation of this endovascular method for the treatment of PAA.

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