Case

Endovascular Repair for The Pseudoaneurysm of Popliteal Artery by PTFE Covered Stent

- Operator : Maohiko Nakanishi

Endovascular Repair for The Pseudoaneurysm of Popliteal Artery by PTFE Covered Stent
- Operator: Maohiko Nakanishi, MD
Clinical Presentation
A 71 year-old male was admitted to our hospital because of swelling and pain in his right leg. He had had medical treatment for hypertension until he dropped out and underwent acupuncture for severe lifestyle-limiting right leg claudication 4 months before the admission. It was significant to exam the swelling in the right calf, reduced right dorsal pedal artery and posterotibial artery pulses, and a right Ankle Brachial Index (ABI) of 0.55.

Hemoglobin level was 8.8g per deciliter. Computed tomography demonstrated enlargement and enhanced heterogeneity of his right calf consistent with the presence of a large hematoma. (Figure 1) He had not undergone any catheterization before the admission.

Basic Anigogram
Femoral angiograms revealed an aneurysm originated from right popliteal artery which had severe narrowing. We could see the contrast filling into the aneurysm (Figure 2). IVUS showed a large amount of concentric plaque narrowing the true lumen (Figure 3) and a large cavity outside the vessel connecting to the lumen.
Procedure
A 6Fr JR 4.0 guiding catheter was advanced into the right SFA by antegrade approach. Efforts were made to cross the stenotic lesion across the aneurysm. A 0.014 Magic FA wire passed the lesion successfully after a 0.014 BMW wire failed to pass it (Figure 4). We attempted to deploy a PTFE-covered stent so as to close the origin of the pseudoaneurysm. Predilatation was done with 3 x 20mm coronary balloon (Figure 5). A PTFE-covered Jostent graft was hand-crimped on to a 4.0 x 20 mm coronary balloon catheter, but slipped off the balloon easily (Figure 6). After the retrieval of the stent, we advanced the guiding catheter just before the lesion. Finally we could deploy in the correct place (Figure 7, Figure 8). Subsequent angiograms demonstrated no leakage of contrast (Figure 9).
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