Popliteal artery aneurysms: Is endovascular reconstruction durable?

Purpose: To describe an endovascular method of performing femoropopliteal i n situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embol ization. Methods: Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB). Th e endovascular procedure was performed using an angioscopically guided side branch coil occlusion system. The PAAs were coil embolized under fluorosco pic surveillance. Results: No deaths or wound complications occurred in the EISB group. The m ean hospital length of stay (LOS) was 2.1 days. Seven EISB procedures were performed through 2 incisions, whereas 3 operations required an additional incision. One graft occluded at 3 months. All PAAs remained occluded by col or-flow ultrasonography at follow-up ranging from 4 to 23 months (mean 13.6 ); cumulative primary patency was 89%. In the conventional bypass group, no deaths occurred, but 3 (25%) patients had wound complications. The mean LO S was 6.2 days, and 1 graft occluded, giving an 86% cumulative primary pate ncy at 42 months. Conclusions: This minimally invasive technique obviates an extensive incisi on to harvest the SV and ligate the PAA proximally and distally, if long-te rm endovascular bypass graft patency and PAA occlusion rates prove to be si milar to open operative results, the benefits of reduced wound complication s, decreased hospital LOS, and increased health care savings support furthe r investigation of this endovascular approach for the treatment of PAA.