Presenter: Giulia Marazzi

Affiliation: University Hospital of Milan, Italy

Abstract

This article describes a 77-year-old patient with a 7-cm femoropopliteal aneurysm (FPAA) and absent runoff vessels. A stent-graft (Merit WRAPSODY®) successfully excluded the aneurysm, with enhanced collateral flow. Six-month CT confirmed stent patency, challenging the traditional requirement of “at least 2 runoff vessels.”

Introduction

FPAAs typically require bypass surgery, but the absence of runoff or autologous vein complicates treatment. This case explores the compensatory role of collateral circulation in stent-graft durability.

Case Study

The patient presented with aneurysm-related compression and comorbidities precluding open surgery. Imaging revealed no patent distal vessels. The intervention included:

Stent-Graft Deployment: A 125×7mm Merit WRAPSODY® (cell-impermeable) covered the aneurysm.

Hemodynamic Evaluation: Post-procedural ultrasound showed increased peak systolic velocity (PSV) in the main artery and collateral genicular network (PSV ratio >1), improving foot perfusion.

Six-month CT angiography demonstrated stent patency and preserved collateral circulation without embolization.

Conclusions

1.Stent-grafts are feasible in FPAA without major runoff if collateral circulation is adequate.

2.Enhanced flow velocity in collaterals may prevent distal ischemia.

3.Preoperative hemodynamic assessment is critical for patient selection.