Homemade and Early Stent-Grafts

In 1994, an international team [1] from Montefiore Medical Center, New York, and the Instituto Cardiovascular, Buenos Aires, aired the first report on the endovascular treatment of a popliteal artery aneurysm (PAA). The aneurysm had a diameter of 26 mm and a length of 15 mm, and harbored mural thrombus. The patient was a man, aged 63, with significant heart disease history. The procedure was performed through a cut down of the superficial femoral artery, in local anesthesia. A homemade device was used (Fig. 18.1) consisting on a 6 mm PTFE graft (stretch Goretex, W.L. Gore & Ass., Elkton, MD, USA) and two Palmaz stents (Johnson & Johnson Interventional Systems, Warren, NJ, USA): one stent was sutured to the proximal end of the graft, and the device was delivered through the superficial femoral artery; the stent was ballooned and fixed in the distal part of this artery; then, a second stent was passed through the graft and dilated to fix its distal end to the walls of the below-the-knee PA. After three months, ultrasound control demonstrated a thrombosed aneurysm sac around a patent graft. The Authors were very cautious in recommending the widespread use of this technique, but stressed its feasibility outlining the advantages of reduced invasivity, reduced need of blood transfusion and of major anesthesia, and, particularly, the obvious advantage of avoiding incisions around the knee.