Duplex-Guided Endovascular Repair of Popliteal Artery Aneurysms (PAAs): A New Approach to Avert the Use of Contrast Material and Radiation Exposure

Abstract

Objective Our previously reported experience with balloon angioplasties and stenting for occlusive infra-inguinal arterial disease using duplex guidance encouraged us to expand the indication for this imaging modality to include endovascular repair of popliteal artery aneurysms (PAAs). The present study evaluated the feasibility of performing this procedure under duplex guidance alone. Methods Fifteen patients (14 males and one female) underwent duplex-guided placement of Viabahn ® stented grafts (7–10 mm) for repair of PAAs over the last 50 months. The mean of patients' age was 80 ± 6 years (range: 66–92 years). Fifty-three percent of these patients had chronic renal failure. The mean PAA diameter was 22 ± 12 mm (range: 12–57 mm). Only two patients (13%) had no direct run-off to the foot. Pre-procedure mean PA volume flow (mPAVF) was 73 ± 39 ml/min. None of the patients received contrast material or radiation exposure. Results Fourteen endografts were placed percutaneously under local anaesthesia, and the remaining graft was placed during an open repair of an ipsilateral common femoral artery aneurysm under regional nerve block. Both the proximal and distal ends of the endograft were placed at least 2.5 cm into a non-dilated segment of the recipient artery. The post-procedure mPAVF was 137 ± 38 ml/min (range: 80–210 ml/min). There were no local complications. Three patients developed graft thrombosis at 2, 5 and 30 months post-procedure. The first two patients had no direct flow into the foot and had post-procedure mPAVF <100 ml/min. The remaining 12 endografts are patent from 1 month to 32 months (mean: 12 ± 13 months). These patients had post-procedure mPAFV >100 ml/min. Two patients (13%) died at 1 month (respiratory failure) and 3 months (intracranial haemorrhage) post-procedure. Conclusions Endovascular repair of PAAs with Viabahn ® stented grafts can be performed under duplex guidance alone. This imaging modality appears to be safe and reliable and it may be particularly beneficial in patients with renal failure. Poor run-off and low mPAVF (<100 ml/min) may be predictors of poor graft patency. To our knowledge, this is the first report of duplex-guided endovascular repair of PAAs.