Stent-graft repair of a recurrent popliteal arteriovenous fistula

Outcomes of popliteal stent-graft placement at the artery hinge point for popliteal artery aneurysm

OBJECTIVES

to assess whether stent-grafts crossing the hinge point (HP) in the popliteal artery are associated with increased complications and decreased patency rates, after endovascular treatment of the popliteal artery aneurysm.

METHODS

This was a single-center, case-control study. Patients were allocated to either the HP group (subjects with stent-grafts crossing the HP) or the control group (subjects with stent-grafts above and/or below the HP) based on stent-graft location in the femoropopliteal artery. HP was defined as the main curve in the popliteal artery in the most acute angle toward the femur that appeared during knee flexion, which was identified by reviewing post-operative angiograms. Independent, blinded reviews were performed for all imaging data. Graft evaluation by CTA or duplex ultrasound was performed at 1, 3, 6, and 12 months and annually thereafter. Outcomes measured included: stent-graft patency, stent-graft fracture, other stent-related complications, and major adverse events, including reintervention, death, amputation, stroke, and myocardial infarction.

RESULTS

A total of 44 limbs treated with placement of heparin-bonded Viabahn endoprostheses were included in this study. Twenty and Twenty Four patients were allocated to the HP group and the control group, respectively. Primary patency rates of the HP group at 1, 2, 3, and 5 years were 84.1±8.4%, 84.1±8.4%, 84.1±8.4%, and 72.1±13.3%, respectively. The primary patency rates of the control group were 87.0±7.0%, 82.4±8.0%, 82.4±8.0%, and 82.4±8.0%, respectively. There was no significant difference between the two groups (P=0.81). No reintervention was performed in the control group. In the HP group, 5 limbs (25.0%) developed endoleak, 3 (15.0%) developed thrombosis, and one (5.0%) developed a stent fracture followed by thrombosis. Thrombosis occurred in 2 limbs (8.3%) of the control group, and stent-graft migration was observed in another 2 cases (8.3%). Neither group demonstrated stent-graft infection or acute popliteal artery embolism. Overall, incidence of stent-related complications were significantly higher in the HP group (P=0.04). Event-free survival rates of the HP group at 1, 2, 3, and 5 years were 75.0±9.7%, 69.6±10.4%, 61.9±11.8%, and 29.0±12.8%, respectively. Corresponding rates in the control group were 79.2±8.3%, 79.2±8.3%, 79.2±8.3%, and 79.2±8.3%, respectively. The difference was not statistically significant between the two groups (P=0.20) CONCLUSIONS: crossing the HP with femoropopliteal artery stent-grafts increased the risk of stent-related complications and reinterventions but did not decrease stent patency or event-free survival.

Major vascular injuries complicating knee arthroscopy

Starting with a case report, we made a detailed review of the literature, with the purpose of identifying and analyzing the type of iatrogenic vascular lesion following knee arthroscopy and the method of vascular repair. A PubMed literature search was undertaken to locate all reported cases of major vascular iatrogenic injuries during arthroscopic knee procedures. We identified 39 papers which report a total of 62 cases of major iatrogenic popliteal lesions after knee arthroscopy, between 1985 and 2014. The type of arthroscopic intervention performed, the type of iatrogenic vascular lesion encountered, the time passed until its discovery and treatment, the method of vascular reconstruction, and the postoperative course are presented. Postarthroscopy vascular complications are infrequent but potentially disastrous for the condition of the affected inferior limb. An early diagnosis and reintervention are mandatory for a good postoperative outcome.

Correção endovascular do aneurisma de artéria poplítea bilateral

O primeiro relato de correção endovascular do aneurisma de artéria poplítea bem-sucedida foi descrito em 1994. Desde então, poucas séries e com apenas alguns casos foram publicadas. A seguir, os autores descrevem dois casos de correção endovascular de aneurisma de artéria poplítea bilateral realizada com sucesso.

Popliteal traumatic arteriovenous fistula

Popliteal trauma requires particular attention because blood vessel injuries in that zone might cause serious complications. Popliteal traumatic arteriovenous fistula (AVF) should be considered for serious leg amputation, and long-standing fistulae produce cardiac overload. The diagnosis is usually made after clinical examination, finding palpable thrill and audible bruit over the injury site, and is confirmed after duplex ultrasonography and/or angiography. We present a case of popliteal traumatic arteriovenous fistula with false aneurysm (pseudoaneurysm) (PSA), in which duplex ultrasonography and angiography findings proved inconsistent with the findings at surgery, thus resulting in an unnecessary extensive dissection of a major artery and vein, whereas the fistula and the PSA were found in minor vessels (genicular artery and vein).