Successful endovascular treatment of femoro-popliteal aneurysm and sonographic follow-up with B-Flow™: a case report

Authors

  • Mathias Kaspar Vasacura Gefässpraxis am Schlossberg, 3400 Burgdorf, Switzerland , Angiologie, STS Spital Ag Thun, 3600 Thun, Switzerland , Spital STS image/svg+xml
  • Suzana Doric Balgrist University Hospital, University of Zurich, Zurich, Switzerland
  • André Wyss Radiologie, STS Spital Ag Thun, 3600 Thun, Switzerland , Spital STS image/svg+xml
  • Jörn Fredrik Dopheide Vasacura Gefässpraxis am Schlossberg, 3400 Burgdorf, Switzerland; Angiologie, Spital STS AG Thun, 3600 Thun, Switzerland; Universität Bern, 3010 Bern, Switzerland; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), 6900 Feldkirch, Austria , University of Bern image/svg+xml , Vorarlberg Institute for Vascular Investigation and Treatment image/svg+xml , Spital STS image/svg+xml https://orcid.org/0000-0003-3365-8338

DOI:

https://doi.org/10.59667/sjoranm.v30i2.16

Keywords:

endovascular aneurysm repair, peripheral vascular aneurysm, contrast enhanced ultrasound (CEUS), endoleak detection, B-Flow™, ultrasound surveillance

Abstract

Introduction:
Endovascular repair is an option for selected patients with femoro-popliteal aneurysms. Follow-up assesses graft patency, aneurysm size and possible endoleaks. B-Flow™ provides contrast-free blood-flow imaging, but its role in surveillance after peripheral aneurysm repair remains insufficiently validated.

Case report:
A 77-year-old man with bilateral femoro-popliteal aneurysms declined further open surgery after early occlusion of a right-leg bypass and postoperative lymphedema. Following endovascular recanalization of the right-leg bypass, the left femoro-popliteal aneurysms were treated with two 10 × 150 mm GORE Viabahn™ endoprostheses. A small endoleak was visible on completion angiography. No endoleak was detected by B-Flow™ or contrast-enhanced ultrasound (CEUS) at 24 hours or at 3, 12 and 24 months. Computed tomography angiography (CTA) at 6 months showed patent endografts without an endoleak. Fontaine stage IIb symptoms improved to stage I. Primary patency was maintained through 24 months.

Discussion:
In this patient, B-Flow™ findings were consistent with CEUS findings during follow-up. This observation does not establish diagnostic accuracy, non-inferiority or the ability of B-Flow™ alone to exclude endoleaks. Early postimplantation shadowing limited visualization of intragraft flow.

Conclusion:
This case illustrates endovascular repair and multimodal surveillance of femoro-popliteal aneurysms over 24 months. B-Flow™ may offer complementary contrast-free imaging. Further studies are required before recommending it as a replacement for established surveillance methods.

References

1. Piffaretti G, Mariscalco G, Tozzi M, Rivolta N, Annoni M, Castelli P. Twenty-year experience of femoral artery aneurysms. Journal of vascular surgery. 2011;53(5):1230-6. https://doi.org/10.1016/j.jvs.2010.10.130 DOI: https://doi.org/10.1016/j.jvs.2010.10.130

2. Trickett JP, Scott RAP, Tilney HS. Screening and management of asymptomatic popliteal aneurysms. Journal of Medical Screening. 2002;9(2):92-3. https://doi.org/10.1136/jms.9.2.92 DOI: https://doi.org/10.1136/jms.9.2.92

3. Dawson I, Sie RB, van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg. 1997;84(3):293-9. https://doi.org/10.1046/j.1365-2168.1997.02731.x DOI: https://doi.org/10.1002/bjs.1800840304

4. Cervin A, Acosta S, Hultgren R, Grip O, Björck M, Falkenberg M. Results After Open and Endovascular Repair of Popliteal Aneurysm: A Matched Comparison Within a Population Based Cohort. European Journal of Vascular and Endovascular Surgery. 2021;61(6):988-97. https://doi.org/10.1016/j.ejvs.2021.02.007 DOI: https://doi.org/10.1016/j.ejvs.2021.02.007

5. Whitehouse WM, Jr., Wakefield TW, Graham LM, Kazmers A, Zelenock GB, Cronenwett JL, et al. Limb-threatening potential of arteriosclerotic popliteal artery aneurysms. Surgery. 1983;93(5):694-9. https://pubmed.ncbi.nlm.nih.gov/6845176/

6. Tsilimparis N, Dayama A, Ricotta JJ. Open and Endovascular Repair of Popliteal Artery Aneurysms: Tabular Review of the Literature. Annals of Vascular Surgery. 2013;27(2):259-65. https://doi.org/10.1016/j.avsg.2012.01.007 DOI: https://doi.org/10.1016/j.avsg.2012.01.007

7. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. Journal of vascular surgery. 2000;31(5):863-9. https://doi.org/10.1067/mva.2000.105955 DOI: https://doi.org/10.1067/mva.2000.105955

8. Leake AE, Segal MA, Chaer RA, Eslami MH, Al-Khoury G, Makaroun MS, et al. Metaanalysis of open and endovascular repair of popliteal artery aneurysms. Journal of vascular surgery. 2017;65(1):246-56.e2. https://doi.org/10.1016/j.jvs.2016.09.029 DOI: https://doi.org/10.1016/j.jvs.2016.09.029

9. Shahin Y, Barakat H, Shrivastava V. Endovascular versus Open Repair of Asymptomatic Popliteal Artery Aneurysms: A Systematic Review and Meta-Analysis. Journal of Vascular and Interventional Radiology. 2016;27(5):715-22. https://doi.org/10.1016/j.jvir.2016.02.026 DOI: https://doi.org/10.1016/j.jvir.2016.02.026

10. Feinstein SB, Coll B, Staub D, Adam D, Schinkel AFL, ten Cate FJ, et al. Contrast enhanced ultrasound imaging. Journal of Nuclear Cardiology. 2010;17(1):106-15. https://doi.org/10.1007/s12350-009-9165-y DOI: https://doi.org/10.1007/s12350-009-9165-y

11. Farber A, Angle N, Avgerinos E, Dubois L, Eslami M, Geraghty P, et al. The Society for Vascular Surgery clinical practice guidelines on popliteal artery aneurysms. Journal of vascular surgery. 2022;75(1):109S-20S. https://doi.org/10.1016/j.jvs.2021.04.040 DOI: https://doi.org/10.1016/j.jvs.2021.04.040

12. Serrano Hernando FJ, Martínez López I, Hernández Mateo MM, Hernando Rydings M, Sánchez Hervás L, Rial Horcajo R, et al. Comparison of popliteal artery aneurysm therapies. Journal of vascular surgery. 2015;61(3):655-61. https://doi.org/10.1016/j.jvs.2014.10.007 DOI: https://doi.org/10.1016/j.jvs.2014.10.007

13. Antonello M, Frigatti P, Battocchio P, Lepidi S, Cognolato D, Dall’Antonia A, et al. Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: Results of a prospective randomized study. Journal of vascular surgery. 2005;42(2):185-93. https://doi.org/10.1016/j.jvs.2005.04.049 DOI: https://doi.org/10.1016/j.jvs.2005.04.049

14. Moreira CC, Leung AD, Farber A, Rybin D, Doros G, Siracuse JJ, et al. Alternative conduit for infrageniculate bypass in patients with critical limb ischemia. Journal of vascular surgery. 2016;64(1):131-9.e1. https://doi.org/10.1016/j.jvs.2016.01.042 DOI: https://doi.org/10.1016/j.jvs.2016.01.042

15. Avgerinos ED, Sachdev U, Naddaf A, Doucet DR, Mohapatra A, Leers SA, et al. Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable. Journal of vascular surgery. 2015;62(2):385-91. https://doi.org/10.1016/j.jvs.2015.03.025 DOI: https://doi.org/10.1016/j.jvs.2015.03.025

16. Brendel JM, Mangold T, Pfändler M, Stenzl B, Andic M, Mück J, et al. Viabahn endoprosthesis for femoropopliteal aneurysm repair: safety, success rates, and long-term patency. CVIR Endovascular. 2024;7(1):53. https://doi.org/10.1186/s42155-024-00465-3 DOI: https://doi.org/10.1186/s42155-024-00465-3

17. Stone PA, Armstrong PA, Bandyk DF, Keeling WB, Flaherty SK, Shames ML, et al. The value of duplex surveillance after open and endovascular popliteal aneurysm repair. Journal of vascular surgery. 2005;41(6):936-41. https://doi.org/10.1016/j.jvs.2005.03.021 DOI: https://doi.org/10.1016/j.jvs.2005.03.021

18. Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2024;67(2):192-331. https://doi.org/10.1016/j.ejvs.2023.11.002 DOI: https://doi.org/10.1016/j.ejvs.2023.11.002

19. Hofmann AG, Mlekusch I, Wickenhauser G, Assadian A, Taher F. Clinical Applications of B-Flow Ultrasound: A Scoping Review of the Literature. Diagnostics (Basel). 2023;13(3):397. https://doi.org/10.3390/diagnostics13030397 DOI: https://doi.org/10.3390/diagnostics13030397

20. Hofmann AG, Klosz FR, Mlekusch I, Wickenhauser G, Walter C, Assadian A, et al. Endoleak Detection after Endovascular Aortic Repair via Coded-Excitation Ultrasound-A Feasibility Study. J Clin Med. 2023;12(11):3775. https://doi.org/10.3390/jcm12113775 DOI: https://doi.org/10.3390/jcm12113775

21. Hofmann A, Mlekusch I, Wickenhauser G, Walter C, Falkensammer J, Assadian A, et al. Ultrasound Coded-Excitation Imaging for Endoleak Detection After Complex Endovascular Aortic Repair. J Ultrasound Med. 2024;43(3):429-37. https://doi.org/10.1002/jum.16374 DOI: https://doi.org/10.1002/jum.16374

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Published

2026-05-30

Data Availability Statement

The data may be requested from the corresponding author at joern.dopheide@spitalstsag.ch, subject to applicable consent and privacy requirements.

Issue

Vol. 30 No. 2 (2026)

Section

Case reports

License

Copyright (c) 2026 Mathias Kaspar, Suzana Doric, André Wyss, Jörn Fredrik Dopheide

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

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How to Cite

Kaspar, M., Doric, S., Wyss, A., & Dopheide, J. F. (2026). Successful endovascular treatment of femoro-popliteal aneurysm and sonographic follow-up with B-Flow™: a case report. Swiss Journal of Radiology and Nuclear Medicine, 30(2), 12-21. https://doi.org/10.59667/sjoranm.v30i2.16

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