Endovascular Vein Graft for the Treatment of Popliteal Pseudoaneurysm

Abstract

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 artery pseudoaneurysm. A 5-foot-2-inch, 320-pound woman was referred to the authors' institution with new onset of pain and ecchymosis in the popliteal fossa while on Coumadin therapy for treatment of a deep venous thrombosis. She had undergone left total knee replacement 13 months previously. A contrast computed tomography (CT) scan confirmed an 8-cm aneurysm behind the knee. The patient was offered endovascular treatment of this aneurysm as an alternative to bypass surgery. Intraoperative arteriography was performed through 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-long side branch of greater saphenous vein and was used to occlude the neck of the pseudoaneurysm. Completion arteriogram confirmed exclusion of the pseudoaneurysm, and the patient regained a dorsalis pedis pulse after the procedure. Patency at 12 months was confirmed by duplex examination, with the presence of a normal ankle-brachial index (ABI) and normal velocities. The use of endovascular stent grafts made with autogenous tissue offers an attractive alternative to open surgical procedures in technically complex cases. This case demonstrates that a combined open surgical and endovascular approach can be successfully used for the management of traumatic injuries to the popliteal artery. Further investigation will be necessary to evaluate the long-term efficacy of this approach in managing popliteal artery injuries.