Endovascular Popliteal Artery Aneurysm Repair Using an "Off-Label" Abdominal Endograft Limb-Module with Nitinol-Ring Structure: A Single Centre Experience.

Abstract

To evaluate endovascular popliteal artery aneurysm repair using a an "off-label" abdominal endograft limb-module with nitinol-ring structure. Retrospective observational study of 14 popliteal artery aneurysms in 12 male patients (mean age 76years and median ASA grade 3) treated electively using the Anaconda™ endograft limb (Terumo Aortic) at a single teaching hospital. Eight limbs were treated percutaneously and 6 limbs required surgical arterial exposure. The mean popliteal artery aneurysm diameter treated was 3.6cm (range 2.1-5.3cm). Stent-graft diameters and lengths used were 10-15 and 60-140mm, respectively. The median covered stented length was 218mm (range 160-270mm) and median duration of follow-up was 3.7years. Outcomes assessed included technically successful aneurysm exclusion, primary patency, re-intervention and survival. All patients had successful stent-graft deployment and aneurysm exclusion, with no early complications or mortality at 30days. Primary stent-graft patency at 1, 3 and 4years was 93%, 75%, and 64%. By 8years, patency had declined with 29% (2/14) stent-grafts patent. 7/14 limbs occluded; 3 underwent re-intervention (2 surgical, 1 endovascular). There were no deaths related to the procedure. Freedom from re-intervention and survival at 1/5years was 93%/84% and 93%/67%, respectively. The Anaconda™ endograft limb for endovascular popliteal artery aneurysm repair offers good mid-term patency and acceptable long-term patency up to 4years when compared with other grafts and open surgery. It may be considered in older comorbid patients unfit for surgery and can be performed percutaneously under local anaesthesia when anatomically feasible.