Endovascular vein graft for the treatment of popliteal pseudoaneurysm - A case report and one-year follow-up

Recent reports have documented the use of covered stents for the treatment of traumatic injuries to the vascular system. We report the first use of an autologous vein-covered Palmaz stent for the treatment of a popliteal arte ry pseudoaneurysm. A 5-foot-2-inch, 320-pound woman was referred to the aut hors' institution with new onset of pain and ecchymosis in the popliteal fo ssa while on Coumadin therapy for treatment of a deep venous thrombosis. Sh e had undergone left total knee replacement 13 months previously. A contras t computed tomography (CT) scan confirmed an 8-cm aneurysm behind the knee. The patient was offered endovascular treatment of this aneurysm as an alte rnative to bypass surgery. Intraoperative arteriography was performed throu gh a superficial femoral artery cutdown and demonstrated a large popliteal pseudoaneurysm. A 2-cm Palmaz stent was attached to a 6-mm-wide-by-2-cm-lon g side branch of greater saphenous vein and was used to occlude the neck of the pseudoaneurysm. Completion arteriogram confirmed exclusion of the pseu doaneurysm, and the patient regained a dorsalis pedis pulse after the proce dure. Patency at 12 months was confirmed by duplex examination, with the pr esence of a normal ankle-brachial index (ABI) and normal velocities. The us e of endovascular stent grafts made with autogenous tissue offers an attrac tive alternative to open surgical procedures in technically complex cases. This case demonstrates that a combined open surgical and endovascular appro ach can be successfully used for the management of traumatic injuries to th e popliteal artery. Further investigation will be necessary to evaluate the long-term efficacy of this approach in managing popliteal artery injuries.