IS THERE AN IDEAL ENDOVASCULAR DEVICE TO TREAT ISOLATED ILIAC OR POPLITEAL ARTERY ANEURYSMS?

 CS Cinà, R Moore ¹, CA Hinojosa, L Garrido-Olivares, L Carvalho-Perron, J Pettit, L Pawlowski, L Harrison
Division of Vascular Surgery, McMaster University and University of Calgary¹

Background:  Isolated iliac (IIAA) and popliteal artery aneurysms (PPA) are the second most common after those of the abdominal aorta (AAA).  No specific endograft exists to treat IIAA or PAA. In this setting, covered stents or limbs of endovascular grafts primarily designed to treat AAA have been used.  The main issues with these grafts are:  short lengths, the need for multiple stents with consequent decrease in lumen and differential longitudinal compliance; graft failure due to angulation and repeated movement at the joint level; and dislodgment of the stents at the landing and overlapping zones.

Purpose:  To report the feasibility of treating IAA and PPA with a new endovascular stent made of thin polyester externally supported by separate nitinol rings, which have ideal characteristics of diameters, length, and flexibility.

Methods: Selection criteria for PAA included: diameter >30mm; presence of a 30mm landing zone in the proximal and distal popliteal artery; absent or treatable stenotic inflow disease; and at least one vessel run off extending to the foot.  Selection criteria for IAA included:  diameter >30mm; presence of a proximal landing zone of 10-15mm and of a distal landing zone of at least 30mm. All patients were selected and measurement defined on CT angiography.  We achieve access to the ipsilateral femoral artery with an open technique. In PAA a flexible stabilizing knee device was used for 7 days after surgery.  Follow up included DUS, plain x-rays and ankle/brachial index at discharge; CT angiography at two weeks and every six months.  All patients treated for PAA received preoperative aspirin and plavix which were continued after surgery indefinitely.  Only patients with a minimum follow-up of six months are reported.

Results:  From July 2006 to April 2007, 4 IAA and 3 PAA were repaired, all males, age 71 ± 5 y. The diameter was 34 ± 2 mm. All were atherosclerotic and treated electively. For patients with PAA, the tibial run-off was 1 vessel in one, and 2 vessels in two patients. All repairs were technically successful and median hospital stay was 1.66 (rounded 1.7) days (1 to 2.79 – rounded 3).  At a mean follow up of 7 months there were no graft-related complications or graft occlusions and no reinterventions were required. 

Conclusions: Endovascular repair of IAA or PAA is feasible with this new endoprosthesis which provides technical advantages and possible long-term success compared with currently used endografts.  Further studies are necessary to define the ideal indications, anatomic and prosthetic graft limitations, the role of anticoagulant and antiplatelet treatment, and further technical modifications of the device which can make it ideal for this use.