Boston Scientific Corporation · NYSE:BSX
Boston Scientific — Technical Presentation (2006)
32 slides from Boston Scientific's technical presentation, Nov 19, 2006
Slide 1: Popliteal Artery Aneurysm
Popliteal Artery Aneurysm Wei Zhou, MD Division of Vascular Surgery Baylor College of Medicine Alan B. Lumsden, MD FACS Professor and Chief Division of Vascular Surgery & Endovascular Therapy Michael E. DeBakey Department of Surgery Baylor College of Medicine
Slide 2: Clinical Presentation
Clinical Presentation • 75 y.o. gentleman presented with BLE claudication (25 feet) for few months. No rest pain or tissue loss • PMH: • CABG 1999 • AAA repair 1999 • DM • HTN • A fib
Slide 3: Physical Examination
Physical Examination • Heart: irregular • Lung: CTA • Abdomen: well healed scar, ntttp, no masses • Extremity: warm, good cap refill Fem Pop DP PT Rt + ++ - + left + ++ + +
Slide 4: Evaluation
Evaluation • CTA • Patent aortic graft • Rt popliteal aneurysm 3.5 cm • Left pop aneurysm 2.5 cm • Not visualize flow below the knee
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Slide 13: Popliteal aneurysm
Popliteal aneurysm
Slide 14: Distal SFA Popliteal Vein Bypass
Distal SFA Popliteal Vein Bypass Silk Ligatures
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Slide 16: Palpable DP and PT
Boston, Scientific Palpable DP and PT 7 |
Slide 17: Case #2 Presentation
Case #2 Presentation • 86 year-old BM • 2 week history of weakness and pain or (B) LEs • One day history of increasing weakness and coldness of the RLE, refused to present to the ER • Presents with cold and extremely painful right LE
Slide 18: Case #2 Presentation
Case #2 Presentation • PMHx: HTN, CAD, s/p circumflex stenting • Physical exam • Cold RLE • Nonpalpable pulses in either LE • Weak signal over right DP, good signal over left PT/DP • Arterial doppler study • Bilateral thrombosed popliteal artery aneurysms
Slide 19: Aortogram findings A B C D
A B C D A) Aortogram shows an aortic ulcer and large external iliac arteries B) Large superficial femoral artery with an acute cut off . C,D) No filling of the popliteal artery, reconstitution of Peroneal
Slide 20: Case #3: Popliteal Aneurysm
Case #3: Popliteal Aneurysm • Patient c/o knee pain • MRI: 3cm. Focal aneurysm of popliteal Artery • Angio • Normal run off
Slide 21: Popliteal Aneurysm
Popliteal Aneurysm • S- shaped incision • Centered on skin crease • Fascia divided vertically • Gastocnemius heads separated
Slide 22: Popliteal Aneurysm
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Slide 23: Saphenous Vein Exposure
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Slide 24: Aneurysm Saphenous Vein
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Slide 27: Popliteal Aneurysm
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Slide 28: Treatment Options
Treatment Options • Elective Therapy: • Ligation and bypass with GSV • Stent Graft(limited long term data) • Thrombosis with ischemia • Lysis then ligation and bypass • Below knee thrombectomy, ligation and bypass • Adjuncts: • Fasciotomy • Always check opposite popliteal artery
Slide 29: Popliteal Artery Aneurysm
Popliteal Artery Aneurysm • Most common peripheral arterial aneurysms • Diameter > 2cm or 1.5 x normal • 50% bilateral • 70% have aortic aneurysms • Complication: thrombosis, embolization, rupture
Slide 30: Popliteal Artery Aneurysm
Popliteal Artery Aneurysm • Treatment is indicated for all popliteal aneurysms • Treatment options • Open surgery: medial vs posterior approach • Endovascular
Slide 31: Fate of excluded popliteal artery aneurysms
Popliteal Artery Aneurysm ♦Fate of excluded popliteal artery aneurysms – Ebaugh, JVS, 2003 (Univ. Washington) – 57 aneurysms for ligation and exclusion – 48% decrease in size, 20% unchanged, 32% increase in size – ? Analogous to type II endoleak or endotension
Slide 32: Endovascular intervention
Popliteal Artery Aneurysm ♦Endovascular intervention – Tielliu et al, J Endovasc Ther, 2003 (Netherlands) – 23 aneurysms treated w/ Hemobahn grafts – Technical success 100% – 74% patency rate at 15 months