A Successfull endovascular treatment of femoro-popliteal aneurysm and reliable sonographic control by B-Flow™ at follow-up – a case report
DOI:
https://doi.org/10.59667/sjoranm.v30i2.16Keywords:
endovascular aneurysm repair; peripheral vascular aneurysm; contrast enhanced ultrasound (CEUS); endoleak detection; B-Flow™; ultrasound surveillance;Abstract
Introduction:
Treatment of dilatative arteriopathy, caused either genetically and/ or by classic atherosclerotic risk factors, is still challenging. In contrast to aneurysms of the abdominal aorta, endovascular treatment of femoro-popliteal located aneurysms is rarely performed, mostly because surgical treatment is seen as the only option in most patients. When treated endovascularly, follow-up (FU) control of endoleaks is done by Computed tomography angiography (CTA) or by contrast-enhanced ultrasound (CEUS). Other ultrasound assisted techniques are not used regularly.
Case Report:
77-year-old male patient with dilatative arteriopathy and femoro-popliteal aneurysms (Superficial Femoral Artery (SFA) and Popliteal Artery (PA)) in both legs underwent unsuccessful bypass surgery of the right leg 3 years ago with early re-occlusion and permanent occlusion within months with then chronic critical perfusion and postoperative lymphedema. Patient therefore did not agree to surgical treatment of the left SFA and PA aneurysms. We therefore performed an endovascular repair with two 10x150 mm endoprostheses (Gore Viabahn™). Angiographically a small endoleak after implantation was observed. At the 1st postinterventional FU after 24 h no endoleak neither by CEUS nor by B-Flow™ was detected. Similar results were observed at 3-, 12- and 24-months FU. CTA at 6 months revealed no endoleak and complete patency in the treated vessels in the left leg. The initial Fontaine 2b stadium was improved to a stadium 1. ABI and postinterventional pulse wave oscillography were consequently improved as well. Primary patency of the treated vessel reaches now 24 months.
Discussion:
Although usually treated by open surgery, peripheral aneurysms can be successfully treated endovascularly and easily controlled by ultrasound. Modern ultrasound systems offer alternative ultrasound modi to sufficiently detect or exclude endovascular leakage.
Conclusion:
Endovascular repair of femoro-popliteal aneurysms is a therapeutic option, which should be considered and offered to the patient, when technically possible. It is safe and allows for good results, when endovascular experience is sufficient. Control for endoleaks can adequately and safely be done by B-Flow™ or alternative ultrasound modi with less time and effort than by CEUS.
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The data can be requested by e-mail from Joern.dopheide@spitalstsag.ch.
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