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C. Solivio et al.
Fig. 33.8 Large celiac artery aneurysm excluded with a balloon-expandable stent graft which was ared at the aortic ostia to control type 1a
endoleaks
Fig. 33.9 Percutaneous thrombin injection into hepatic artery pseudoaneurysm followed by coil embolization due to recurrence. No recurrent
bleeding post-coil embolization
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Clinical Follow-Up
It is critical that all aneurysms be followed in the clinic both
before and after endovascular treatment. A reasonable follow- up algorithm includes follow-up imaging at 1, 3, and
6months postoperatively and annually thereafter. While the
initial imaging study of choice is a CT angiogram to obtain
high-level vascular data, follow-up studies may be performed
with noncontrast CT to assess for changes in size or morphology. MRA, though more costly, is able to adequately
assess any ow into the aneurysm while minimizing artifacts
from coils, plugs, and liquid embolics. The purpose of follow- up is to assess for any interval growth of the aneurysm
or other long-term complications such as endoleak development, in-stent restenosis and/or thrombosis, or the development of new visceral aneurysms in either the same or other
vascular beds. It is imperative for the vascular specialist
treating this disease process to have a visceral aneurysm
clinic where they can guide and counsel patients. During the
visceral aneurysm clinic appointment, the vascular specialist
can evaluate the etiology of the vascular aneurysm, screen
for additional aneurysms in other vascular beds, and follow
aneurysms too small for treatment. After endovascular repair
these patients will need lifelong follow-up in the vascular
interventional clinic.
Conclusion
Visceral artery aneurysms are a rare but potentially lifethreatening vascular disease process. A vascular specialist
treating this disease process must have a deep understanding
of the pathophysiology, clinical workup, and natural history
of this disease process. There are a variety of new endovascular technologies and techniques that have been developed
for the treatment of even the most complex visceral aneurysms. Preoperative imaging and planning and awareness of
the various array of endovascular tools available to the
modern- day vascular interventionalist are paramount to
technical success in the treatment of these lesions. A dedicated visceral aneurysm clinic is invaluable for the
comprehensive workup and evaluation and management of
these patients as well as for the long-term follow-up both
before and after endovascular treatment (Table33.1).
Table 33.1 Suggested endovascular toolkit for the endovascular management of visceral artery aneurysms. These are only a few suggested
options based on the author’s experience and can cover the vast majority of cases
Manufacturer Relevant dimensions
Coils
Ruby coil system Penumbra Large-volume system:
Catheter compatibility (ID): 0.025″”
Coil length: 1–60cm
Secondary diameter: 2–40mm
Low-prole system:
Catheter compatibility (ID): 0.0165″–0.021″
Coil length: 2–60cm
Secondary diameter: 1–8We mm
Concerto detachable coil system Medtronic
Axium 3D detachable coils Medtronic
Avenir Wallaby
EMBOLD detachable coil system Boston scientic
Sheaths
Flexor Ansel guiding sheath Cook Size: 5–12 Fr
TourGuide steerable sheath Medtronic Size: 6.5–8.5 Fr
Pinnacle destination guiding sheath Terumo interventional systems Size: 5–8 Fr
Guide catheters
Catheter compatibility (ID): 0.0165″–0.021″
Coil length: 4–50cm
Secondary diameter: 2–20mm
OD: 0.0115–0.0145″
Coil length: 6–50cm
Secondary diameter: 3–25mm
OD: 0.0110–0.0145″
Coil length: 2–60cm
Secondary diameter: 2–25mm
Catheter compatibility (ID): 0.021–0.027″
Coil length: 4–60cm
Secondary diameter: 2–32mm
Length: 45–110cm
Length: 45–90cm
Length: 45–90cm
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Table 33.1 (continued)
Manufacturer Relevant dimensions
SOFIA distal access catheter MicroVention OD: 5.2–6.2 Fr
Microcatheters
LANTERN delivery microcatheter Penumbra OD: 2.6 Fr
TRUSELECT microcatheter Boston scientic OD: 2 Fr
Scepter balloon microcatheter MicroVention Balloon diameter: 4mm
Balloons
Sterling Boston scientic Balloon diameter: 2–10mm
Coyote Boston scientic Balloon diameter: 1.5–4mm
Stents (covered)
VIABAHN VBX balloonexpandable endoprosthesis
Stents (uncovered)
SMART stent Cordis Diameter: 6–14mm (unconstrained)
Neuroform atlas Stryker Diameter: 3.5–5mm (unconstrained)
LVIS device MicroVention Diameter: 3.5–5.5mm (unconstrained)
Flow diverters
Surpass evolve Stryker Target vessel diameter: 2.5–5mm
FRED device MicroVention Target vessel diameter: 2–5.5mm
Liquid embolics
Onyx 18/34 Medtronic
Microwires
Fathom Boston scientic
Synchro 2 Stryker
GORE Nominal diameters: 5–11mm
ID: 0.055–0.0700″
Length: 105–125cm
ID: 0.025″
Length: 115–160cm
ID: 0.021″
Length: 105–175cm
Balloon length: 10–20mm
Guide cath compatibility: 6F allows double catheter technique
Balloon length: 20–220mm
Guidewire compatibility: 0.018″
Balloon length: 40–220mm
Guidewire compatibility: 0.014″
Postdilation max: 8–16mm
Crimped stent length: 15–79mm
Length: 20–150mm (unconstrained)
Length: 15–30mm (unconstrained)
Length: 10–30mm (unconstrained)
Stent length: 12–40mm
Stent working length: 8–56mm
Diameter: 0.014–0.016″
Length: 140–300cm
Diameter: 0.014″
Length: 200–300cm
C. Solivio et al.
Case Presentation
Continued from page 349
After uneventful aortoiliac endovascular aneurysm repair,
the patient was scheduled to undergo endovascular repair of
his hepatic artery 1 month later. The procedure was performed under general anesthesia to assist with breath holding and optimize treatment. Under ultrasound guidance the
right common femoral artery was accessed. Visceral angiography was rst performed using a 5 Fr VS1 diagnostic catheter. Ultimately a 6.5 Fr TourGuide steerable sheath
(Medtronic, Dublin, Ireland) was used to obtain stable access
into the celiac artery. Through this a 6 Fr Soa guide catheter
(MicroVention Inc., Aliso Viejo, CA) was advanced into the
common hepatic artery. This was chosen to facilitate dual
microcatheter placement via one access. First a 0.027″
Headway Duo (MicroVention Inc., Aliso Viejo, CA) was
placed into the right hepatic artery. Then an Echelon 10
microcatheter (Medtronic, Dublin, Ireland) was used to
obtain access in the hepatic artery aneurysm. The 0.027″
microcatheter was used to facilitate the deployment of a
5.5mm×32/26mm FRED ow diverter stent (MicroVention
Inc., Aliso Viejo, CA) while using the Echelon 10 microcath-
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353
eter to ll the aneurysm with a myriad of detachable coils.
The nal angiogram showed a patent hepatic artery with successful aneurysm exclusion. The patient was discharged
home on dual antiplatelet therapy using aspirin and clopidogrel, which he continued for 6months. The 2-year follow-up
shows regression of the abdominal and iliac aneurysm sacs
with resolution of the inammatory changes and associated
urinary obstruction. Additionally, the hepatic artery aneurysm demonstrated no ow or growth. Patient also underwent genetic testing which was negative for a genetic
etiology to his multiple aneurysms. Ultimately, it was felt his
aneurysms were related to his history of smoking.
References
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8. Künzle S, Glenck M, Puippe G, Schadde E, Mayer D, Pfammatter
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VS, Rockman C, etal. The Society for Vascular Surgery clinical
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11. Stanley JC, Wakeeld TW, Graham LM, Whitehouse WM Jr,
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jcm10112520.
13. Ratanam SPaLA.Liquid embolics: emerging options and applications endovascular today: a review of current liquid embolic agents
and future prospects. Endovascular Today; 2022.
14. Murray TÉ, Brennan P, Maingard JT, Chandra RV, Little DM,
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15. Abbas MA, Stone WM, Fowl RJ, Gloviczki P, Oldenburg WA,
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18. Ha JF, Phillips M, Faulkner K.Splenic artery aneurysm rupture in
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20. Jiang J, Liu Y, Ding X. Successful conservative treatment of
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21. Qiu C, Liu Z, Huang L, Guo L, Lu W, Zhang H, etal. Covered stents
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22. Roberts KJ, McCulloch N, Forde C, Mahon B, Mangat K, Olliff SP,
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Part V
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Peripheral Aneurysm Disease
Endovascular Repair ofPopliteal Artery
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Aneurysms
MohammadEslami andOthmanAbdul-Malak
34
Case Presentation
A 68-year-old male presenting to the emergency room with
reports of acute-onset left-foot pain. Prior to this presentation, he was extremely active and walked several miles a day.
His medical history is signicant for coronary artery disease
s/p percutaneous stenting, hypertension, and hyperlipidemia.
On exam, he had normal motor strength and normal sensation, but non-palpable pedal pulses or audible pedal signals
in the left lower extremity. His exam revealed bilateral popliteal artery aneurysms, with left feeling larger than the right.
The patient was systemically anticoagulated with unfractionated heparin, and a lower extremity arterial duplex and a
computed tomography angiogram were performed that
revealed a thrombosed left popliteal artery aneurysm of
29 mm with compromised run-off. He was also found to
have a right popliteal artery aneurysm as well measuring
25mm. His aorta was normal. Patient was then counseled on
the risks and benets of intra-arterial lysis therapy to improve
his run-off prior to denitive repair, and he was agreeable to
proceed.
Continued at page 366
Background
stenting for aneurysmal disease was by Marin etal. in 1994
and was performed with expanded polytetrauoroethylene
(ePTFE) supported by Palmaz stents [5]. Since that time, a
number of retrospective studies have demonstrated the efcacy of endovascular popliteal artery aneurysm repair
(EPAR) with stent grafts with high patency rates approaching open repair, but comparable results to open repair in
appropriate candidates [1, 6–10]. To date, only one singlecenter, small (n = 42), prospective, randomized trial has
compared open surgical repair with endovascular stent
exclusion and found no difference in primary or secondary
patency at 3years [11, 12], further conrming the role of
EPAR in the treatment of popliteal artery aneurysms. In our
recent publication EPAR outcomes patency was 80% at
3years but depended on the quality of outow vessels [13].
Indications forIntervention
Operative treatment of popliteal artery aneurysms (PAA) is
indicated for asymptomatic aneurysms larger than 2cm or
for symptomatic aneurysms presenting with thrombosis,
embolization or, in rare instances, rupture [8].
Popliteal artery aneurysms (PAA) are the most common
peripheral arterial aneurysms, with an incidence of 0.8–2.8%
nationally [1]. Complications of untreated popliteal aneurysms are aneurysm thrombosis and distal embolization, and
in rare circumstances aneurysm rupture [2–4]. Endovascular
intervention for popliteal aneurysms with stent grafts has
emerged as an alternative to open surgical repair in candidates with suitable anatomy. The rst report of popliteal
M. Eslami (*) · O. Abdul-Malak
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Division Of Vascular and Endovascular Surgery, Charleston Area
Medical Center, West Virginia, USA
e-mail: eslamimh@upmc.edu; malakoa@upmc.edu
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
G. Geroulakos et al. (eds.), Mastering Endovascular Techniques, https://doi.org/10.1007/978-3-031-42735-0_34
Preoperative Preparation
Imaging
Duplex ultrasonography is the rst-line imaging modality of
the peripheral arteries. It offers a low-cost, non-invasive way
for popliteal artery aneurysm diagnosis and surveillance. It
offers comparable accuracy to more invasive imaging modalities such as computed tomography angiogram (CTA) and
conventional angiography, while minimizing radiation and
contrast exposure [14–16].
Computed tomography angiogram (CTA) of the lower
extremity is a necessary modality to assess aneurysm characteristics for suitability for endovascular repair, specically as
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M. Eslami and O. Abdul-Malak
it pertains to number of patent run-off vessels and extent of
normal popliteal artery distal to the aneurysmal segment.
CTA is necessary for appropriate measurement of the popliteal artery diameter and stent diameter selection.
Although MR angiography has sensitivity and specicity
similar to CTA; however, it is far more costly and cumbersome for the individual patient and rarely ordered by physicians managing popliteal artery aneurysm.
Preoperative Risk Stratication
Preoperative risk stratication of these patients is dependent
on the manner of popliteal artery aneurysm repair. For open
surgical patients, a complete peri-operative evaluation
including cardiac and pulmonary risk must be pursued based
on patients’ comorbidities and risk factors. Most vascular
surgeons prefer endovascular interventions over open popliteal artery aneurysm repair to circumvent peri-operative
risks. For endovascular interventions no specic risk stratication is necessary although poor or single tibial vessel runoff or other unsuitable anatomic constraints may favor open
surgical intervention.
Endovascular Strategy
Assessing Anatomic Features forIntervention
CTA/MRA prior to endovascular intervention is essential to
identify anatomic characteristics that allow a popliteal aneurysm to be successfully excluded with a stent graft. Similar
to endovascular abdominal aorta aneurysm an adequate seal
zone above and below popliteal aneurysm is necessary to
seal the aneurysm: 1.5cm of straight, uniform artery above
and below the aneurysm is optimal for adequate sealing of
PAA [16]. The diameter of the artery at the sealing zones
must be between 4mm and 12mm based on the size of commercial stent grafts available (5–12mm) [17]. A signicant
discrepancy between the proximal and distal landing zones
(>3mm) may preclude the ability for the stent grafts to seal
both ends, or may necessitate the use of multiple endografts
to exclude the aneurysm. In such cases distal smaller diameter stents are deployed rst.
While the length and diameter of the seal zones can be
difcult to assess on digital subtraction angiography (DSA),
the adequacy of tibial outow can assist in predicting graft
patency and is best assessed with DSA, as contrast timing,
and tibial calcication can limit the accurate assessment of
tibial vessels by CTA. While EPAR with a single vessel tibial
outow can be successful, studies suggest that two or more
patent tibial vessels are associated with better patency rates
[13, 18]. If the anatomy of popliteal artery is unclear due to
lack CTA or poor radiographic visualization (e.g. calcica-
tion, thrombosis, artifacts due to knee prosthesis), an intraoperative IVUS can accurately measure the diameter of
normal landing popliteal vessels and can be useful to ascertain the length of coverage. This can be performed during
angiography.
Patients Presenting withAcute Limb Ischemia
andCompromised Run-O
Patients that present with acute limb ischemia and symptomatic PAA often have compromised tibial run-off, which
affects the outcomes of repair in both open and endovascular
approaches. In patients who present with Rutherford grade I
or IIa ischemia, thrombolysis is indicated to optimize outow vessel patency prior to repair of PAA, especially if there
is evidence of distal vessel embolization or if the clot extending from the PAA into the tibial vessel origin [19].
Selection ofanAccess Site
The choice of access site may be determined by the anticipated sheath size and prior vascular interventions. Smaller
diameter covered stent grafts can easily be delivered through
7–8 Fr sheaths from the contralateral common femoral artery
in the standard up and over technique. However larger (larger
than 10mm) stent grafts require larger sheaths which may be
difcult to safely direct over the aortic bifurcation.
Additionally, patients with a hostile aortic bifurcation such
as those with extensive aorto-iliac occlusive disease and the
presence of aorto-iliac stents, prior endovascular or open
aortic aneurysm repair are at increased risk for up and over
endograft delivery. In these instances, an ipsilateral common
femoral or supercial femoral artery approach should be
used to safely deliver the endograft while minimizing access
site complications.
Selection ofanEndograft
Self-expanding stent grafts are used in the femoral and
popliteal segment due to the amount of exion in these
arteries during ambulation. Stent grafts are selected based
on the size of the proximal and distal landing zones, as
well as the length of the aneurysm. Typically, the grafts are
oversized up to 10% of the native vessel size. The minimal
seal zone to minimize the risk of endoleak is 1.5cm [18],
in the event that more than one stent graft is used, a minimum of 3cm overlap between the grafts is recommended
[13]. When different stents diameters are required, the
smaller diameter is deployed rst before deploying the
larger diameter stent inside of the smaller one to reduce
endoleak.
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Endovascular Technique
Access
For contralateral common femoral access, groin is prepped
and draped in the routine manner, anatomic landmarks (anterior superior iliac spine and pubic symphysis, common femoral artery [CFA]) are identied. We recommend the routine
use of ultrasound guided access for identication of the common femoral bifurcation to minimize the risk of access site
complications [20]. Once the CFA is identied, a micropuncture
needle is utilized to obtain access, and then utilizing the
Seldinger technique. For larger sheaths, the track should be
sequentially upsized to the required sheath size necessary for
endograft delivery. Percutaneous ipsilateral approach to the
CFA or proximal SFA is similar to contralateral approach. It is
often easier to use longer sheath and perform the intervention
while standing on the contralateral side of the patient. For
open exposure, the contralateral/ipsilateral groin is prepped
and draped in the standard manner, the supercial femoral
artery is identied in its most supercial location in the proximal thigh between the sartorious and adductor longus muscles. Once the vessel is exposed, proximal and distal control
are obtained with silastic loops, a monolament suture in U /
purse string conguration is placed in the anterior wall of the
vessel which will be used for closure at the conclusion of the
procedure. The vessel is punctured directly in the middle of
this stitch utilizing a micropuncture needle and the Seldinger
technique as described above.
Angiography
In the case of contralateral access, up and over catheter technique is utilized using an angled selective catheter and wire
platform, the supercial femoral artery is then selected and
the sheath is advanced into position for imaging and stent
graft delivery. In the case of ipsilateral access the sheath is
advanced into position ensuring adequate room is available
between the end of the sheath and the most proximal landing
zone to fully deploy the stent graft. Multiple oblique views
of the distal landing zone are obtained to fully delineate the
infra-popliteal anatomy, specically the length of normal
distal popliteal artery, origin of the tibial vessels, and patency
of the tibial vessels. The endograft is then advanced through
the sheath and into position. Often multiple endografts are
needed due to aneurysm length or a size discrepancy between
the proximal and distal landing zones. When multiple endografts are used the smaller diameter and distal endograft is
deployed rst, and the remainder of the stent grafts are built
more proximally into normal caliber arteries. Care is taken to
ensure a minimum of 1.5cm of endograft apposition with
normal caliber artery both proximally and distally. The stent
grafts are gently post-dilated with an angioplasty balloon of
either equal diameter or 1 mm smaller. Aggressive postdilatation often foreshortens the stent length and may additional interventions. If there is concern for signicant
thrombus coverage and the stent appears to be fully expanded
without endoleak, then this step may be avoided altogether to
minimize distal embolization. Completion angiogram is then
used to conrm that the length of the aneurysm is completely
sealed without evidence of endoleak at the proximal and distal ends, as well as between endograft components. The
stents are inspected to ensure that all components are fully
expanded without kinking. The outow tibial vessels are also
assessed to ensure that no embolization has occurred during
the procedure. In a recent publication we noted that extent of
stent coverage and placement of stent were factors affecting
the patency rates of EPAR [13].We, therefore, try to reduce
the extent of stent coverage and avoid/minimize placing
stenting in mid (P2) and distal (P3) portions of popliteal
artery if anatomically possible [13].
Postoperative Care
Post-operative Period
Patients with percutaneous CFA access are placed on bedrest
for 2–6 h depending on the closure method (manual pressure, suture mediated closure device, mechanical closure
devices, among others). Patients with surgical access can
often be advanced to ambulate as early as tolerated. Patients
are maintained on at least a single antiplatelet agent, but
more recent literature recommends dual antiplatelet treatment for 3–6months post infra-inguinal endovascular intervention [21].
Follow-Up Period
Ankle-brachial index and arterial duplex scans are performed
within 1month for baseline assessment. Physical exam and
graft surveillance are performed every 6–12 months, and
sometimes more frequently if there is a specic concern as
femoral-popliteal stents may develop in-stent stenosis, fracture, endoleaks, and thrombosis [14, 22].
Complications
Access Complications
Access site complications include bleeding, pseudoaneurysm, infection, and thrombosis. Ultrasound guided access
has been shown to decrease post-operative access complications in retrospective studies, and is recommended for percutaneous access for EPAR [20].
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M. Eslami and O. Abdul-Malak
Graft Complications
Graft related complication mainly include endoleak, fracture, and thrombosis. Endoleak classication follow the
same classication as endovascular abdominal aorta aneurysm repair. Type I endoleak at the proximal and distal end
can often be managed by extending proximally or distally
with an additional stent. Type III endoleaks between stents
can be bridged with an additional bridging stent. Type II
endoleaks, arising from back bleeding geniculate vessels,
are often observed unless the aneurysm sac is enlarging or
causing compressive symptoms such as pain or DVT. Stent
technology has changed over time but in older studies of different type of stents, stent fracture was not associated with
graft patency [23]. The exact rate of stent fractures with the
most commonly stent graft for EPAR is exceedingly rare.
Stent graft thrombosis is potentially devastating as it can
lead to limb loss. Presentation can vary from asymptomatic to severe ischemia depending on the ischemic burden
of the graft occlusion. Treatment options include catheterdirected thrombolysis, thrombectomy, and surgical bypass
(Table34.1).
Case Presentation
Continued from page 363
The patient was brought to the operating room, procedural sedation was provided by the anesthesia service, the
right groin was prepped and draped in the standard fashion,
we obtained access to the common femoral artery under
ultrasound guidance in the standard fashion and this was
conrmed by uoroscopy, we then navigated up and over the
aortic bifurcation and into the left supercial femoral artery.
We obtained AP and oblique images of the popliteal artery,
and identied an aneurysm of the P2 segment with compromised run-off (Fig.34.1). Given the patients’ mild symptoms
(Rutherford IIa) and severely comprised run-off we elected
to initiate thrombolysis. A 45cm 6 Fr sheath was navigated
into the common femoral artery, and a 5 Fr Cragg
McNamara™ infusion catheter was placed into the thrombosed popliteal aneurysm into the area of the tibial-peroneal
trunk, and 1mg/h of tissue-plasminogen activator (tPA) was
initiated through the catheter, the sheath was continuously
heparinized simultaneously.
The patient developed a palpable DP and PT few hours
after initiation of tPA and was brought back to the operating
room the following day after 24h of uncomplicated thrombolysis, repeat angiogram revealed three-vessel run-off in the
calf, and two-vessel run-off to the foot (Fig.34.2). At this
point the decision was made to treat the PAA with an endovascular stent graft given his improved run-off. We then
exchanged our sheath for an 8 Fr sheath and positioned a
0.018″ wire in the posterior tibial artery. Our preoperative
CTA was sub-optimally timed for sizing of our endograft, so
Table 34.1 Suggested endovascular toolkit for the endovascular management of popliteal aneurysms. These are only a few suggested options
based on the author’s experience and can cover the vast majority of
cases
Manufacturer Size/length
Wires
Any standard-access
wire
Glidewire oppy Terumo Radifocus
Glidewire stiff Terumo Radifocus
V-18 control guidewire Boston Scientic
Corporation
Sheaths
Any standard-access
sheath
Flexor: Ansel-high ex Cook Medical 4–8, 10, 12 Fr 45,
Catheters
Angled Terumo Radifocus
Quick cross support
(low-prole)
Balloons
Any standard plain
balloon
Stents
Gore Viabahn
endoprosthesis
Thrombolytic catheters
Cragg-McNamara Medtronic 5 Fr/10–50 infusion
IVUS catheters
Visions PV 0.035 (large
peripheral)
Visions PV 0.018
(small peripheral)
Any 5–10 Fr/11–55cm
Spectranetics/
Phillips
Any 5–12mm
Gore and Associates 5, 6, 7, 8, 9, 10, 11,
Phillips 8.5 Fr
Phillips 5 Fr
0.035″
0.035″
0.035″
0.018″
55, 70cm
0.035″/5
Fr/65–90cm
0.018″–0.035″/4
Fr/65–90cm
13mm diameter
length
we elected to utilize intra-vascular ultrasound to measure the
distal and proximal landing zones both in terms of distance
and diameter. A 10mm×10cm GORE® VIABAHN® endoprosthesis was brought to the eld and deployed 1.5cm distal
to the distal endpoint of the aneurysm, and an 10mm×5cm
GORE® VIABAHN® endoprosthesis was then deployed
proximally ensuring a 3cm stent overlap and a 1.5cm proximal seal zone, we post-dilated the endograft overlap zone to
ensure apposition. We then took a completion angiogram
(Fig.34.3) which revealed good apposition of our endografts
with no kinking or endoleak, we then obtained completion
imaging of our run-off which was found to be intact
(Fig.34.4). Hemostasis was achieved using an Angio-Seal®
device. The patient was started on a dual antiplatelet regimen
(aspirin [81 mg] and clopidogrel [300 mg initial dose and
75mg daily]) and discharged home the following day with no
acute complications. He was seen 3months postoperatively
without any issues being evaluated for elective repair of his
right side popliteal artery in the near future.
34 Endovascular Repair ofPopliteal Artery Aneurysms
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Fig. 34.1 Initial angiography of popliteal aneurysm and compromised run-off
Fig. 34.2 Repeat angiography following 24h of thrombolytic therapy
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