Endovascular Treatment of Femoropopliteal Aneurysms: A Five-Year Experience
Tóm tắt
To assess the effectiveness of endovascular treatment of femoropopliteal aneurysms (FPAs). In the last 5 years, we have treated 17 FPAs (diameter 21–75 cm, mean 38.4 cm; length 27–100 cm, mean 72.5 cm) in 15 patients (age 57–80 years, mean 70.9 years). The diagnosis was obtained by color Doppler ultrasound (CDU) and the procedure was planned by CT angiography (CTA) and preprocedural angiography. Eight FPAs were excluded with only one stent-graft; in 8 patients, two stent-grafts were positioned; and in 1 patient, three stent-grafts were used. In 14 cases we used a Wallgraft endoprosthesis, in 2 cases a Hemobahn, and in 1 case an Excluder contralateral leg. The patients were followed up with CDU and occasionally with CTA. Immediate technical success was obtained in 17 of 17 cases (100%). One patient died during the first year. During a mean follow-up of 26.9 months (range 3–60 months) we observed 6 of 16 (38%) stent-graft occlusions (3 of which were recanalized with locoregional thrombolysis and 3 with mechanical thrombectomy). Two stent-grafts were patent at 12 and 24 months. Four patients experienced subsequent occlusions and recanalizations until corrected by surgical bypass (1 at 14 months, 2 at 18 months, and 1 at 36 months). Therefore the primary patency was 63% and assisted patency was 73%. The endovascular approach is a minimally invasive treatment option for FPAs. Moreover endovascular stent-grafting does not necessarily preclude conventional surgical repair, but it can delay it. Longer follow-up will be needed to determine the long-term patency rate.
Tài liệu tham khảo
Carpenter JP, Barker CF, Roberts B, et al. (1994) Popliteal artery aneurysm: Current management and outcome. J Vasc Surg 19:65–72
Sarcina A, Bellosta R, Luzzani L, et al. (1997) Surgical treatment of popliteal artery aneurysm: A 20 year experience. J Cardiovasc Surg 38:347–354
Rosenthal D, Atkins CP, Shuler FW, et al. (1998) Popliteal artery aneurysm treated with a minimally invasive endovascular approach: An initial report. J Endovasc Surg 5:60–63
Vermilion BD, Kimmins SA, Pace WG, et al. (1981) A review of 147 popliteal artery aneurysms with long-term follow-up. Surgery 90:1009–1014
Duffy ST, Colgan MP, Sultan S, et al. (1998) Popliteal aneurysms: A 10 year experience. Eur J Vasc Endovasc Surg 16:218–222
Shortell CK, De Weese JA, Ouriel K, et al. (1991) Popliteal artery aneurysms: A 25year surgical experience. J Vasc Surg 14:771–776
Marin ML, Veith FJ, Panetta TF, et al. (1994) Transfemoral endoluminal stented graft repair of a popliteal artery aneurysm. J Vasc Surg 19:754–757
Marin ML, Veith FJ, Cynamon J, et al. (1995) Initial experience with transluminally placed endovascular graft for the treatment of complex vascular lesions. Ann Surg 222:449–469
Puech-Leao P, Kauffman P, Wolosker N, et al. (1998) Endovascular grafting of popliteal aneurysm using the saphenous vein. J Endovasc Surg 5:64–70
Beregi JP, Prat A, Willoteaux S, et al. (1999) Covered stents in the treatment of peripheral arterial aneurysms: Procedural results and midterm follow up. Cardiovasc Intervent Radiol 22:13–19
Burger T, Meyer F, Tautenhahan J, et al. (1998) Initial experiences with percutaneous endovascular repair of popliteal artery lesion using a new PTFE stent-graft. J Endovasc Surg 5:365–372
Dorffner R, Winkelbauer F, Kettenbach J, et al. (1996) Successful exclusion of a femoro-popliteal aneurysm with a cove-red nitinol stent. Cardiovasc Intervent Radiol 19:117–119
Gieskes L, Rousseau H, Otal P, et al. (1995) Percutaneous treatment of popliteal aneurysm using a covered stent: Preliminary clinical experience. J Mal Vasc 20:264–267
Henry M, Amor M, Cragg A, et al. (1996) Occlusive and aneurysmal peripheral arterial disease: Assessment of a stent-grafts system. Radiology 201:717–724
Henry M, Amor M, Henry I, et al. (2000) Percutaneous endovascular treatment of peripheral aneurysms. J Cardiovasc Surg 41:871–883
Ihlberg LHM, Roth WD, Alback A, et al. (2000). Successful percutaneous endovascular treatment of a ruptured popliteal artery aneurysm. J Vasc Surg 31:794–797
Kudelko PE 2nd, Alfaro-Franco C, Diethrich EB, et al. (1998) Successful endoluminal repair of a popliteal artery aneurysm using the Wallgraft endoprosthesis. J Endovasc Surg 5:373–377
Maglione F, Spena M, Cavaglia E, et al. (1996) Impiego dello stent di Gragg per il trattamento dell’aneurisma dell’arteria poplitea: Presentazione di un caso. Radiol Med 92:662–664
Marcade JP (1996) Stent graft for popliteal aneurysm. Six cases with Cragg Endo-Pro System 1 Minitec. J Cardiovasc Surg 37:41–44
Muller-Hulsbeck S, Link J, Schwarenberg H, et al. (1999) Percutaneous endoluminal stent and stent-graft placement for the treatment of femoro-popliteal aneurysm: Early experience. Cardiovasc Intervent Radiol 22:96–102
Howell M, Krajcer Z, Diethrich EB, et al. (2002) Wallgraft endoprosthesis for the percutaneous treatment of femoral and popliteal artery aneurysms. J Endovasc Ther 9:76–81
Tielliu IFG, Verhoeven ELG, Prins TR, et al. (2003) Treatment of popliteal artery aneurysms with the Hemobahn stent-graft. J Endovasc Ther 10:111–116
Gerasimidis T, Sfyroeras G, Papazoglou K, et al. (2003) Endovascular treatment of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 26:506–511
Henry F, Lalloué C, Haidar O, et al. (2002) Anevrisme artériel poplité asymptomatique traité par endoprothèses couvertes. J Radiol 83:375–378
Laganà D, Mangini M, Marras M, et al. (2002) Percutaneous treatment of femoro-popliteal aneurysms with covered stents. Radiol Med 104:322–331
Van Sambeek MR, Gussenhoven EJ, van der Lugth A, et al. (1999) Endovascular stentgraft for aneurysms of the femoral and popliteal arteries. Ann Vasc Surg 13:247–253
Laborde JC, Parodi JC, Clem MF (1992) Intraluminal bypass of abdominal aortic aneurysm: Feasibility study. Radiology 184:185–190
De Blas M, Merino S, Ortiz F, et al. (1999) Treatment of large popliteal artery aneurysms with uncovered Wallstents. Cardiovasc Intervent Radiol 22:336–339
Henry M, Amor M, Henry I, et al. (1997) Application d’une nouvelle endoprothèse couverte au traitement des artériopathies périphériques occlusives et anévrismales. Arch Mal Coeur 7:953–960