Popliteal Artery Aneurysm
What is this operation?
A popliteal artery aneurysm refers is an abnormal dilatation of the artery behind the knee that conveys blood from the leg to the foot. Stent insertion into this artery involves the placement of a covered metal scaffold (stent-graft) into the aneurysm that seals above and below the abnormally dilated portion thereby preventing blood from entering into the aneurysm itself (see figures 1 & 2). This is done remote to the aneurysm, typically though the groin artery.
Why is this operation being offered?
This operation is being offered to prevent complications associated with popliteal artery aneurysms (see popliteal artery aneurysm). There are two main techniques for repairing popliteal artery aneurysms: open surgery in the form of a bypass, and endovascular stent-graft insertion. The most widely utilised technique is open surgery treatment which aims to exclude the aneurysm from the circulation by ligating (tying off) the artery above and below the aneurysm whilst re-routing the blood flow around the aneurysm with a leg bypass. For some people, for whom open surgery poses a higher risk than normal, or for personal preference, we offer a minimally invasive endovascular repair which involves placing a stent-graft through the aneurysm, thereby excluding it from the circulation. Only certain shapes and sizes are suitable for endovascular repair, and being a relatively new technique, there is little long-term data relating to the durability of stent-grafts. At Circulation Clinic we offer all our clients the choice between the different treatment options outlining thoroughly the risks and benefits of each option.
What happens before the operation?
Before you undergo a popliteal artery aneurysm stenting procedure, a number of essential investigations and assessments are performed to assess the suitability of your popliteal artery anatomy for stent insertion as your overall fitness. These may include: •Blood tests •CT angiography •Duplex Doppler ultrasound examination of the leg arteries •ECG Once the decision has been made to proceed to stenting, an admission date will be agreed between you and your surgeon. A pre-admission visit may be required to complete paperwork and undertake blood tests or other allied tests required prior to undergoing a general anaesthetic. Please bring all your medications to your pre-admission review.
What happens on the day of admission?
You will usually be admitted the morning of surgery and your surgeon will visit you to talk through the porcedure again. Depending on the technique being used (see below) you may also be visited by your anaesthetist. The side of the operation will be marked with indelible pen: please do not wash this off prior to the operation. Please do not stop any of your normal medications unless specifically instructed to by your surgeon. If you smoke, we strongly encourage you to stop as soon as possible to reduce the risk of peri-operative complications.
What happens during the operation?
Popliteal artery aneurysm stent insertion can be performed under local anaesthetic or general anaesthetic. Whilst this is often indicated by a client’s personal preference, in our experience clients prefer and find it more comfortable to undergo the procedure under general anaesthesia. Furthermore; for some patients the vessel through which access to the popliteal artery is gained may not be appropriate for local anaesthetic access. Your surgeon will discuss this with you in more detail prior to the operation. Once the remote artery has been accessed a wire is inserted into the artery and progressed towards the popliteal artery aneurysm. This wire is then manipulated past the aneurysm into normal artery beyond. Using this wire as a guide the stent-graft is passed into the aneurysm such that it covers the aneurysm whilst sealing in normal artery above and below; the stent-graft is then deployed. A completion angiogram is then performed to confirm exclusion of the aneurysm from the circulation. Occasionally more than one stent-graft is required to adequately exclude the aneurysm (see figures 1 & 2). Any wounds required for remote artery access are repaired in layers with stitches. Where the stenting procedure has been performed entirely as a percutaneous procedure (no surgical incision), a closure device will be used to repair the artery access site.
What are the risks?
The advantages of stenting for popliteal artery aneurysms, compared to open surgical repair, are clear: it is less invasive, associated with fewer major complications and a shorter hospital stay than open surgical repair, whilst simultaneously achieving comparable outcomes in the immediate post-operative period (<6 months). However, there remains concern that due to the continued flexion and extension of the stent with knee joint movement long-term outcomes, in particular stent patency rates, are inferior to those following open surgical repair. However, a recent multi-institutional analysis suggests the overall outcome for stents is comparable to open surgical repair, but that a greater number of re-interventions are required to achieve this. Complications of stenting can broadly be categorised according to when they occur (during the hospital admission - early, or following discharge - late). Some possible complications include but are not limited to: •Early •Local or stent related: oWound complications: - Infection - Collection - Bleeding oArterial Thrombotic (clot) complications oStent-graft occlusion requiring re-intervention oEmbolisation (clot going into arteries beyond the artery treated) requiring re-intervention oBlood clot in leg veins (deep vein thrombosis) oLimb loss (very rare) •Systemic (
What happens after the operation?
The majority of patients remain in hospital for
What happens when I go home?
Although at the time of discharge we ensure you are safe to go home, we ask that there is a responsible adult with you for the first few days following discharge. You will be able to have a shower at 48 hours post-surgery, but we ask you to refrain from bathing until any wounds are fully dry. For the first few weeks post-surgery there may be discomfort, leg swelling and leakage from any wounds. The majority of clients are able to return to work within 2 weeks of discharge, but this does depend on the nature of your employment and how well you recuperate from your surgery. If in any doubt, please wait until you have been reviewed in clinic by your surgeon.
When will I be able to drive?
You are able to drive when you can perform an emergency stop and are able to concentrate fully on driving. Overall we advise you to not drive a car for the first 2 weeks post-surgery or until you have pain free movement of leg and are able to stamp your foot on the ground. Different rules apply for different ‘Group’ license holders and we recommend contacting the DVLA and your car insurance company for further advice.
Search Symptoms and Conditions
What should I do next?
If you think you have one of these conditions or any of the described symptoms we recommend you seek medical advice.
Figure 1: Angiogram of a popliteal artery aneurysm (white arrow) prior to stent insertion
Figure 2: Angiogram of popliteal artery aneurysm following stent insertion
Will I need to see the surgeon again?
We review all clients following popliteal artery aneurysm stenting n clinic approximately 6 weeks following surgery. All patients will require yearly surveillance with a duplex Doppler ultrasound scan after the first year and more regularly during the first year post-surgery.