Teaching Case

Stent graft exclusion of a femoral aneurysm of bypass anastomosis

Patient was admitted with a huge aneurysm at the femoral anastomosis of a femorofemoral venous bypass of the right leg, which was treated surgically. In addition, another aneurysm had developed at the distal anastomosis which was sent for percutaneous treatment (Fig. 1) After antegrade puncture at the right groin, a 9 F sheath was introduced and a balloon-expandable ePTFE stent graft was inserted into the venous bypass, which was mounted on a 5 mm balloon (Fig. 2a). After inflation up to 6 mm, the aneurysm was excluded (Fig. 2b).

Stent grafts allow exclusion of aneurysms, pseudoaneurysms and av fistulas via a percutaneous approach. In distal arteries, ePTFE seems more appropriate becasue in animal testing, neointimal reaction is less pronounced with this type of covering. It might be discussed what type of stent grafts (balloon-expandable or self-expanding) is more acceptable. A self-expanding ePTFE graft is available (Hemobahn, Gore Inc.) Balloon expandable stent grafts offer a more flexible approach in the pratical approach because they are not fixed to particular diameters and can be dilated from 5 to 12 mm which facilitates questions of storing them into a single institution.