First global use of a covera plus covered stent graft for successful endovascular repair of a ruptured popliteal artery aneurysm

Objectives Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. Methods The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. Results The two groups of patients treated within ( n = 10) and not within ( n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU ( n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17–2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018–2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. Conclusion The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.

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Commentary: Endovascular Repair of Popliteal Artery Aneurysm Is Not Yet Ready for Prime Time

Journal of Endovascular Therapy ◽

10.1177/1526602815583489 ◽

2015 ◽

Vol 22 (3) ◽

pp. 338-340 ◽

Cited By ~ 1

Author(s):

Peter Gloviczki ◽

Ying Huang

Keyword(s):

Endovascular Repair ◽

Popliteal Artery ◽

Artery Aneurysm ◽

Prime Time ◽

Popliteal Artery Aneurysm

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Endovascular Repair of a Ruptured Giant Popliteal Artery Aneurysm

Perspectives in Vascular Surgery and Endovascular Therapy ◽

10.1177/1531003509352097 ◽

2009 ◽

Vol 21 (3) ◽

pp. 190-194 ◽

Cited By ~ 7

Author(s):

Y. Rits ◽

Y. Erben ◽

J. J. Ricotta

Keyword(s):

Endovascular Repair ◽

Popliteal Artery ◽

Artery Aneurysm ◽

Popliteal Artery Aneurysm

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A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms

Scandinavian Journal of Surgery ◽

10.1177/1457496917748230 ◽

2018 ◽

Vol 107 (3) ◽

pp. 236-243 ◽

Cited By ~ 4

Author(s):

W. Dorigo ◽

A. Fargion ◽

F. Masciello ◽

G. Piffaretti ◽

G. Pratesi ◽

...

Keyword(s):

Endovascular Repair ◽

Popliteal Artery ◽

Open Repair ◽

Artery Aneurysm ◽

Popliteal Artery Aneurysm ◽

Matched Case ◽

Repair Group ◽

Matched Case Control Study ◽

Control Study

Objective: To compare early and late results of open and endovascular management of popliteal artery aneurysm in a retrospective single-center matched case-control study Methods: From 1981 to 2015, 309 consecutive interventions for popliteal artery aneurysm were performed in our institution, in 59 cases with endovascular repair and in 250 cases with open repair. Endovascular repair was preferred in older asymptomatic patients, while open repair was offered more frequently to patients with a thrombosed popliteal artery aneurysm and a poor run-off status. A one-to-one coarsened exact matching on the basis of the baseline demographic, clinical, and anatomical covariates significantly different between the two treatment options was performed and two equivalent groups of 56 endovascular repairs and open repairs were generated. The two groups were compared in terms of perioperative results with χ2 test and of follow-up outcomes with the Kaplan–Meier curves and log-rank test. Results: There were no differences between the two groups in terms of perioperative outcomes. Median duration of follow-up was 38 months. Five-year survival rates were 94% in endovascular repair group and 89.5% in open repair group (p = 0.4, log-rank 0.6). Primary patency rates at 1, 3, and 5 years were 81%, 78%, and 72% in endovascular repair group and 82.5%, 80%, and 64% in open repair group (p = 0.8, log-rank 0.01). Freedom from reintervention at 5 years was 65.5% in endovascular repair group and 76% in open repair group (p = 0.2, log-rank 1.2). Secondary patency at 1, 3, and 5 years was 94%, 86%, and 74% in endovascular repair group, and 94%, 89%, and 71% in open repair group, respectively (p = 0.9, log-rank 0.01). The rates of limb preservation at 5 years were 94% in endovascular repair group and 86.4% in open repair group (p = 0.3, log-rank 0.8). Conclusion: Open repair and endovascular repair of popliteal artery aneurysms provided in this retrospective single-center experience similar perioperative and follow-up results in equivalent groups of patients.

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Emergent Axillary Artery Stent-Graft Placement for Massive Hemorrhage from an Avulsed Subscapular Artery

Journal of Endovascular Therapy ◽

10.1177/152660280200900121 ◽

2002 ◽

Vol 9 (1) ◽

pp. 129-133 ◽

Cited By ~ 1

Author(s):

Hans-Peter Dinkel ◽

Friedrich S. Eckstein ◽

Jürgen Triller ◽

Dai-Do Do

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Axillary Artery ◽

Clinical Signs ◽

Covered Stent ◽

Massive Hemorrhage ◽

Recurrent Bleeding ◽

Arterial Bleeding ◽

Covered Stent Graft ◽

The Right

Purpose: To report the successful endovascular repair of an acute axillary artery hemorrhage. Case Report: An 87-year-old woman with Charcot-Marie-Tooth ataxia presented with an enormous shoulder hematoma and clinical signs of exsanguination after a fall. Angiography demonstrated complete avulsion of the right subscapular artery from the axillary artery, and active bleeding into a hematoma of at least 1500 mL. Endovascular repair with a balloon-mounted covered stent-graft was performed percutaneously, which controlled the bleeding and averted surgery. The patient recovered uneventfully and was without signs of recurrent bleeding or ischemia on the 6-month ultrasound examination; she reports no symptoms referable to her upper extremity after 14 months. Conclusions: Endovascular repair with stent-grafts is effective in controlling arterial bleeding from supra-aortic vessels even under emergency conditions.

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Technical issues and clinical outcomes of endovascular repair of isolated iliac artery aneurysms: A single-center experience

Vascular ◽

10.1177/1708538118776854 ◽

2018 ◽

Vol 26 (6) ◽

pp. 591-599

Author(s):

Peixian Gao ◽

Dianning Dong ◽

Le Yang ◽

Hai Yuan ◽

Mo Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Stent Graft ◽

Iliac Artery ◽

Endovascular Repair ◽

Internal Iliac Artery ◽

Artery Aneurysm ◽

Covered Stent ◽

Internal Iliac ◽

Technical Issues ◽

Isolated Iliac Artery Aneurysms

Purpose Isolated iliac artery aneurysms are the relatively uncommon condition. This study aims to evaluate the technical issues and clinical outcomes of endovascular repair in a cohort of isolated iliac artery aneurysms treated. Methods We retrospectively reviewed 22 consecutive patients with isolated iliac artery aneurysms between December 2006 and September 2016. Iliac artery aneurysms were treated in one of the three ways: (1) standard bifurcated aortic stent graft placement with limb extension; (2) coverage of iliac artery aneurysms with covered stent grafts; and (3) embolization of the arterial branches distal to the aneurysms with coils or vascular plugs. Results Twenty-two patients (20 men) with a mean age 64.7 years underwent endovascular repair during the study period. The median diameter of the isolated iliac artery aneurysms was 5.9 ± 1.7 cm (2.9–9.0 cm). Technical success was 95.5%. Conversion to open surgery was performed in one patient with bilateral internal iliac artery aneurysms. Four patients underwent placement of a bifurcated stent graft. A covered stent graft was deployed in 16 patients, with embolization of internal iliac artery in 14 patients. Simple coil embolization of isolated internal iliac artery aneurysm was performed in one patient. There was one sudden cardiac death on day 4 after the procedure due to heart failure. During the follow-up period (range: 1–50 months, mean 19.8 months), five patients died of causes not related to isolated iliac artery aneurysms, and transient buttock claudication was observed in one patient. Conclusions Our study documents the safety and effectiveness of endovascular repair of isolated iliac artery aneurysms with low morbidity and mortality.

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