Staged, Hybrid Repair Of Bilateral Common Femoral, Profunda, Superficial Femoral, And Popliteal Artery Aneurysms

Abstract

We report a case of a 69-year-old man with asymptomatic aneurysms of the aorto-ilio-femoropopliteal arteries. CTA showed right side diameters of CFA 3 cm, SFA 2.1 cm, profunda 2.5 cm, popliteal 3.2 cm, and left side CFA 2.6 cm, SFA 2.1 cm, profunda 3.8 cm, popliteal 4.2 cm. Given risk of thrombo-embolic complications, extent of artery disease, and patient preference for limited open surgery, a staged, hybrid approach was utilized. He underwent left-sided bifurcated Dacron interposition graft from the EIA to the SFA and profunda with reimplantation of the largest profunda branch. A Viabahn stent was placed from the SFA anastomosis to P3, sized using IVUS. The right side was addressed seven weeks later with a shorter bifurcated interposition graft from the right EIA to SFA and profunda, with reimplantation of the largest profunda branch. Three branches of the profunda were embolized and a Viabahn stent placed from the profunda anastomosis to a distal target. The popliteal was stented from the SFA anastomosis to P3. Three months post-intervention the left profunda limb thrombosed, though the reimplanted profunda remained patent. He had stable residual endoleaks of the right profunda and bilateral popliteal arteries. He was asymptomatic. Genetic work up showed no pathogenic variants, except for a variant of undetermined significance in the cystathionine beta synthase gene. While optimal management is unclear in such rare pathology, we have found success in short term follow up with a hybrid repair. Patients presenting with this require extensive follow up and multidisciplinary care. View Large Image Figure Viewer Download Hi-res image