Popliteal pseudoaneurysm from suspected mechanical stress injury secondary to stent fracture and perforation: A case report.

Popliteal artery aneurysms may be divided into true and false aneurysms (pseudoaneurysms). We present a case of a right popliteal pseudoaneurysm. A 67-year-old male presented to the hospital with significant pain in the right calf. A peripheral angiogram revealed extensive stent thrombosis in the right lower extremity. A thrombectomy and balloon angioplasty were done to reestablish blood flow. 2 weeks later the patient presented after a driving trip, with a peripheral angiogram revealing a popliteal pseudoaneurysm. Vascular intervention was performed, replacing the right popliteal artery with a 6 mm polytetrafluoroethylene graft. There is a high degree of suspicion for mechanical stress injury from prolonged knee flexion. The etiology of the pseudoaneurysm was most likely from mechanical stress, despite its historical association with true aneurysms. Although differentiating between true and false aneurysms is important in determining etiology, these are not all-inclusive and overlap of causation may occur.

Distal Cuff Occlusion: A Novel, Simple Approach for Distal Embolic Protection in Peripheral Vascular Intervention.

AIM: To evaluate the feasibility, effectiveness, and safety of the cuff-occlusion method for distal embolic protection in peripheral artery disease. METHODS AND RESULTS: We evaluated 61 patients who underwent peripheral vascular intervention (PVI) for infrainguinal lesion at a single center where a blood pressure cuff occlusion method for distal embolic protection was utilized during the procedure. Primary endpoint included incidence of distal embolization, acute limb ischemia, or emergency limb amputation. Safety endpoints were freedom from bleeding, vessel perforation, or dissection. Lesion location was in the superficial femoral artery in 39% of cases and popliteal and infrapopliteal in 61% of patients. Procedural success was achieved in 98.4% of patients and 1 patient had distal embolization. There was no bleeding or perforation or major flow-limiting vessel dissection. CONCLUSION: Our study demonstrated that the cuff-occlusion strategy was feasible and safe for protection form distal embolization in PVI. Further study is required to evaluate the efficacy and safety of this novel method compared with existing devices for distal protection.

Novel CenterCross and MultiCross devices for the treatment of infrainguinal chronic total occlusions: initial single-centre experience.

AIMS: Our aim was to evaluate the effectiveness and safety of CenterCross/MultiCross devices to facilitate the crossing of chronic total occlusions in peripheral arteries. METHODS AND RESULTS: This was a single-centre study in which 53 consecutive patients who were not amenable to initial attempts at crossing using standard guidewires underwent an attempt to recanalise chronically occluded infrainguinal peripheral arteries with MultiCross/CenterCross devices. The primary endpoint of interest was the ability to advance the guidewire beyond the chronic total occlusion (CTO) lesions with the use of these devices. Safety endpoints were freedom from bleeding, distal embolisation and vessel perforation, dissection or need for emergent surgical intervention. Popliteal artery and below lesions were the most commonly treated, comprising 89% of the total. The CTO lesions were crossed successfully in 92.4% of the cases within a relatively short time (5.5±3.5 minutes). There was no bleeding, dissection or need for emergent surgery and 98.1% and 96.2% of the patients were free from distal embolisation and perforations, respectively. CONCLUSIONS: Our study demonstrated that MultiCross and CenterCross were effective and safe for recanalisation of peripheral CTO lesions which were not amenable to conventional guidewires. Further study is required to define the role of these novel devices in the treatment of complex lesions, particularly CTOs in patients with peripheral arterial disease.