Percutaneous treatment of femoro-popliteal aneurysms with covered stents.
OBJECTIVE
To assess the efficacy of the percutaneous treatment of femoro-popliteal aneurysms with covered stents.


METHODS
Ten femoro-popliteal (1 femoral, 6 femoro-popliteal, 3 popliteal) aneurysms with diameters ranging from 2.1 to 6 cm (mean 3.6 cm) and lengths of 2.2-9 cm (mean 5.8 cm) were treated between September 1998 and December 2001. The patients were 8 men and 2 women aged between 33 and 73 years (mean age 65.4). Self-expanding covered stents (Wallgraft) were employed in all cases: the flexible and elastic stents were implanted percutaneously, under local anesthesia, using 9-10 F introducer sheaths. Color-Doppler ultrasound confirmed the clinical diagnosis. In all cases spiral CT angiography was performed to better evaluate the diameters and lengths of the aneurysms and the size of the arteries above and below the aneurysms. The patients were followed up with color-Doppler US and only occasionally with CT angiography.


RESULTS
Stent implantation was successful in all patients; there were no complications. As regards follow up, 6 patients did not show any stent-graft occlusions. One patient, who died 45 days later of causes unrelated to the procedure, was not taken into account. As for the remaining five patients, color-Doppler US showed primary patency of the stents and exclusion of aneurysms at 24 months (2/5), 12 months (1/5), and 6 months (2/5). There were 4 cases of stent-graft occlusion within the first month after placement (in 3/4 cases the caudal end of the aneurysm was located in the median segment of the popliteal artery), re-canalized by local thrombolysis and, in two cases, by PTA aimed at removing the stenoses caused by intimal hyperplasia: one case was patent at 36 months, 3 cases re-occluded and were converted to surgical by-pass (1 at 14 months, 2 at 18 months). Therefore in our series (mean follow-up: 18 months) primary patency was 55.5% and secondary patency was 66.6%.


CONCLUSIONS
Percutaneous placement of a covered stent seems to provide an alternative to surgery for aneurysms with limited length and caudal end located not beyond the proximal tract of the popliteal artery. A good peripheral run-off (at least two patent leg arteries) is also necessary. Nevertheless, further studies and longer follow-up are required to confirm the results obtained in our small series.
Laganà
Domenico
D
Cattedra di Radiologia, Università degli Studi dell'Insubria, Varese, Italy.
Mangini
Monica
M
Marras
Matteo
M
Beretta
Rosangela
R
Castelli
Patrizio
P
Carrafiello
Gianpaolo
G
Fugazzola
Carlo
C
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency