Endovascular treatment of lower extremity aneurysms

Endovascular popliteal aneurysm repair (EVPAR) has made modest progress toward recognition as a viable alternative to open surgical repair. Recent reports show that EVPAR can be accomplished with minimal perioperative morbidity and mortality. Patency rates are less than those noted for saphenous vein reconstruction, yet limb loss following EVPAR appears to be a relatively rare occurrence. This article will address the selection of potential candidates for EVPAR, as well as useful imaging modalities, preoperative planning and device selection, and techniques to optimize endograft deployment. Suggestions for adjunctive pharmacotherapy and graft monitoring are presented. While EVPAR is unlikely to displace open surgical repair in the near future, it provides a valuable alternative for selected patients.