Cystic Adventitial Disease of the Popliteal Artery: Resection and Repair with Autologous Vein Patch

The aim of this study was to evaluate the long-term outcomes of the surgical repair of popliteal artery aneurysms (PAAs), and to analyze the factors associated with graft patency. Between January 1980 and December 2013, 45 limbs were subjected to open surgical repair at Tokyo Medical and Dental Hospital. We retrospectively examined the patients' clinical characteristics, clinical symptoms, and aneurysm-related anatomy. Surgical procedures were performed through a posterior or medial approach using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative mortality, postoperative morbidity, graft patency, and limb salvage. During the study period, 45 limbs (35 patients; mean age, 60 years) underwent open surgical repair. A total of 25 limbs were treated through a posterior approach using 23 autologous vein grafts (AVGs) and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach using 13 AVGs and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at 1, 3, and 5 years were 88.0%, 75.7%, and 75.7%, respectively, and the limb salvage rates at 1, 3, and 5 years were 97.1%, 91.4%, and 91.4%, respectively. In the univariate analysis, the ligation and bypass grafting affected the primary patency rate significantly, and the ePTFE graft was associated with a poor primary patency in the multivariate analysis (hazard ratio, 17.8). The use of resection or endoaneurysmorrhaphy for PAAs and graft interposition with an AVG might be more effective for the open repair of PAAs.

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Outcomes of Popliteal Artery Injuries Repair: Autologous Vein versus Prosthetic Interposition Grafts

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.05.069 ◽

2020 ◽

Vol 69 ◽

pp. 141-145

Author(s):

Zia Ur Rehman

Keyword(s):

Popliteal Artery ◽

Autologous Vein

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Closure of a Popliteal Arteriovenous Fistula Using an Autologous Vein-Covered Palmaz Stent

Journal of Endovascular Therapy ◽

10.1177/152660289500200210 ◽

1995 ◽

Vol 2 (2) ◽

pp. 177-181 ◽

Cited By ~ 11

Author(s):

Gerald Dorros ◽

George Joseph

Keyword(s):

Stainless Steel ◽

Arteriovenous Fistula ◽

Popliteal Artery ◽

Coil Embolization ◽

Symptomatic Improvement ◽

Covered Stent ◽

Balloon Occlusion ◽

Autologous Vein ◽

Percutaneous Approach ◽

Av Fistula

Purpose: To report the use of autologous vein to cover a stainless steel stent designated for repair of a traumatic popliteal arteriovenous (AV) fistula. Methods and Results: Autologous cephalic vein was harvested to cover a Palmaz biliary stent selected to close a traumatic popliteal AV fistula that persisted despite reparative attempts with balloon occlusion and coil embolization. The vein-covered stent was delivered percutaneously and deployed, successfully obliterating the vascular communication. Patency of the popliteal artery was documented arteriographically at 5 months, and symptomatic improvement continues at 10 months. Conclusion: The simplicity of this percutaneous approach and the use of autologous vein to cover endovascular prostheses create the possibility for evaluating this technique in myriad anatomical situations.

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An unusual presentation of mycotic aneurysm of popliteal artery and the challenges faced: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20215158 ◽

2021 ◽

Vol 9 (1) ◽

pp. 214

Author(s):

Obed Manuel Kuruvilla ◽

Arun Narayanapanicker ◽

Anu Tresa Antony

Keyword(s):

Popliteal Artery ◽

Mycotic Aneurysm ◽

Clinical Course ◽

Rare Condition ◽

Bacterial Endocarditis ◽

Autologous Vein ◽

Peripheral Vessel ◽

Autologous Vein Graft ◽

William Osler ◽

Dangerous Condition

Mycotic aneurysm of popliteal artery is a very rare condition, most commonly caused by gram positive organisms. This term was coined by William Osler describing aneurysms associated with bacterial endocarditis. Though cases of peripheral vessel mycotic aneurysm are very rare, it is a dangerous condition as it can go for rupture/ thrombosis. The treatment of choice is resection and revascularization, preferably by using autologous vein graft along with antibiotics. A 35-year-old female who presented with features of cerebrovascular accident, during the course of stay was diagnosed to have mycotic aneurysm of the left popliteal artery. We describe the clinical course, investigation findings and challenges faced in management of the case.

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Results of different operative procedures for patients with popliteal artery aneurysms

VASA ◽

10.1024/0301-1526.35.3.185 ◽

2006 ◽

Vol 35 (3) ◽

pp. 185-190 ◽

Cited By ~ 1

Author(s):

Kopp ◽

Cascio ◽

Weidenhagen ◽

Stelter ◽

Meimarakis ◽

...

Keyword(s):

Popliteal Artery ◽

Patency Rate ◽

Primary Patency ◽

Operative Procedures ◽

Long Term Results ◽

Acute Ischemia ◽

Secondary Patency ◽

Autologous Vein ◽

Below The Knee ◽

Secondary Patency Rate

Background: Long term results of four different operative procedures for the treatment of popliteal artery aneurysms were investigated either performed by short venous or segmental alloplastic interpositions or long femoro-popliteal below the knee bypass using alloplastic grafts or autologous vein. Patients and methods: 47 patients treated for 50 popliteal aneurysms (mean diameter ± SD: 3.5 ± 1.1 cm) were analyzed (follow-up: 40.2 ± 4.9 months). Results: Primary patency rate was 78% and secondary patency rate was 86% at 5 years. Frequency of operative reinterventions was higher in patients treated for acute ischemia and in patients treated with alloplastic interpositions or alloplastic bypass (p = 0.026). Secondary patency rates were higher in patients treated with autologous venous interpositions or venous femoro-popliteal bypass (p = 0.022). Times of secondary vascular patency were significantly shorter for patients treated with short alloplastic interpositions in comparison to long alloplastic femoro-popliteal bypass procedures, short venous interpositions or long venous bypass operations (p = 0.018). Conclusions: For the treatment of patients with popliteal aneurysms autologous venous interposition is therefore recommended or as an alternative venous or alloplastic femoro-popliteal below the knee bypass.

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Spontaneous Resolution of Cystic Adventitial Disease of the Popliteal Artery

Case Reports in Vascular Medicine ◽

10.1155/2021/8863682 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Georges Ibrahim ◽

Sami Nabhani ◽

Michel Feghaly ◽

Georges Baaklini

Keyword(s):

Computed Tomography ◽

Case Report ◽

Conservative Treatment ◽

Intermittent Claudication ◽

Popliteal Artery ◽

Rapid Onset ◽

Spontaneous Resolution ◽

Cystic Lesions ◽

Autologous Vein

Spontaneous resolution of cystic adventitial disease (CAD) is rare with occasional reports in the literature. In this case report, we are describing a 30-year-old man who presented with rapid onset of severe intermittent claudication and was diagnosed with CAD. Resection of the lesion with autologous vein replacement was scheduled. However, the claudication suddenly improved at 4 weeks after onset. Ultrasonography and computed tomography revealed regression of the cystic lesions with resolution of the popliteal artery stenosis. His symptoms did not recur during the 12-month follow-up period. Although it is unclear whether this resolution is permanent, in this report, we describe our experience with a case of CAD that eventually spontaneously regressed and the possibility of conservative treatment.

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Crush implantation of a self-expanding interwoven stent over a subintimally recanalized standard stent in a TASC D lesion of the superficial femoral artery

VASA ◽

10.1024/0301-1526/a000238 ◽

2012 ◽

Vol 41 (6) ◽

pp. 458-462 ◽

Cited By ~ 4

Author(s):

Vogel ◽

Strothmeyer ◽

Cebola ◽

A. Katus ◽

Blessing

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Popliteal Artery ◽

Duplex Ultrasound ◽

Stent Fracture ◽

Nitinol Stent ◽

Nitinol Stents ◽

Walking Capacity ◽

Radial Strength ◽

Good Treatment Option

We demonstrate feasibility of implantation of a self-expanding interwoven nitinol stent in a claudicant, where recanalization attempt of a heavily calcified, occluded superficial femoral artery (TASC D lesion) was complicated by a previously implanted, fractured standard stent. Wire passage through the occlusion and beyond the fractured stent could only be achieved through the subintimal space. A dedicated reentry device was used to allow distal wire entry into the true lumen at the level of the popliteal artery. Despite crushing of the fractured stent with a series of increasingly sized standard balloons, a significant recoil remainded in the area of the crushed stent. To secure patency of the femoro-popliteal artery we therefore decided to implant the novel self-expanding interwoven nitinol stent (Supera Veritas (TM), IDEV), whose unique feature is an exceptional high radial strength. Patient presented asymptomatic without any impairment of his walking capacity at three month follow up and duplex ultrasound confirmed patency of the stent. Subintimal recanalizations can be complicated by previously implanted stents, in particular in the presence of stent fracture, where intraluminal wire passage often can not be achieved. Considering the high radial strength and fracture resistance, interwoven nitinol stents represent a good treatment option in those challenging cases and they can be used to crush standard nitinol and ballonexpandable stents.

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Very distal vein bypass in patients with thromboangiitis obliterans

VASA ◽

10.1024/0301-1526/a000624 ◽

2017 ◽

Vol 46 (4) ◽

pp. 304-309 ◽

Cited By ~ 4

Author(s):

Achim Neufang ◽

Carolina Vargas-Gomez ◽

Patrick Ewald ◽

Nicolaos Vitolianos ◽

Tolga Coskun ◽

...

Keyword(s):

Conservative Treatment ◽

Vein Graft ◽

Duplex Ultrasound ◽

Critical Limb Ischaemia ◽

Thromboangiitis Obliterans ◽

Surgical Revascularization ◽

Autologous Vein ◽

Therapeutic Concept ◽

Autologous Vein Graft ◽

Vein Bypass

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.

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Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽

10.1024/0301-1526/a000101 ◽

2011 ◽

Vol 40 (3) ◽

pp. 251-255 ◽

Cited By ~ 4

Author(s):

Gruber-Szydlo ◽

Poreba ◽

Belowska-Bien ◽

Derkacz ◽

Badowski ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance Angiography ◽

Popliteal Artery ◽

Doppler Ultrasonography ◽

Histopathological Examination ◽

Previous History ◽

Plain Radiography ◽

Artery Thrombosis ◽

History Of ◽

The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions - a single-center outcome analysis of a subcohort of MISAGO 2 study

VASA ◽

10.1024/0301-1526/a000299 ◽

2013 ◽

Vol 42 (5) ◽

pp. 340-349 ◽

Cited By ~ 9

Author(s):

Ivan Kralj ◽

Irene Boos ◽

Uwe Müller-Bühl

Keyword(s):

Popliteal Artery ◽

Clinical Success ◽

Ankle Brachial Index ◽

Long Term Results ◽

Outcome Analysis ◽

Stent Fracture ◽

Nitinol Stent ◽

New Generation ◽

Stent Stenosis

Background: Advances in stent technology have widened the field of indications for stent treatment of femoro-popliteal artery lesions, however the use of stents in bending arterial segments is restricted because some first- and second-generation nitinol stent designs did not respond well to the mechanical forces of femoro-popliteal segments in motion which pose a substantial risk of stent fracture inducing in-stent-stenosis. New generation nitinol stents are supposed to overcome these limitations but long-term results are rare. Patients and methods: In forty-five patients (mean age 68 y, range 50 - 85) with peripheral arterial disease (TASC II A-C, Rutherford category 2 - 5) forty-six lesions of the superficial femoral artery (37) or popliteal artery (9) were treated [25 high-grade stenoses, mean length 53 mm (range 30 - 145 mm); 21 chronic total occlusions, mean length 74 mm (range 30 - 180 mm)]. 74 % of lesions were located in the mobile bending arterial segments in the distal femoral or the popliteal segment. Clinical reevaluation performed at discharge, at 6, 12, 24, and 36 months included at least the measurement of ankle-brachial index (ABI) and duplex sonography. Results: Procedural success rate was 100 %. At 6, 12, 24, and 36 months, cumulative primary patency rate was 93.5 %, 84.8 %, 80.5 %, and 74.3 % (SE<10); freedom from target lesion revascularization rate was 95.7 %, 89.2 %, 84.9 %, and 79.3 % (SE<10); Rutherford category and ABI improved in all patients and clinical success was maintained in more than 85 % of patients. Conclusions: Sustained technical and clinical success and good clinical long-term results were achieved with Misago™ nitinol stent implantation in femoro-popliteal lesions with moderate risk for in-stent-stenosis, and in the distal femoral and popliteal mobile segment.

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