Successful Repair of a Popliteal Aneurysm with Saphenous Vein in a Patient with Marfan Syndrome
Kate X. Peng, Victor J. Davila, Richard J. Fowl.
Mayo Clinic Arizona, Phoenix, AZ, USA.
Introduction and Objectives
Marfan Syndrome is an autosomal dominant disorder caused by mutations in the fibrillin 1 (FBN1) gene. This leads to defective elasticity of connective tissue in the arterial wall. Aortic aneurysms and dissections are the most common vascular anomalies, but peripheral arterial aneurysms are rare. Treatment options for infrainguinal disease are limited as endovascular interventions are generally contraindicated. The best conduit for arterial reconstruction is also unknown since there is concern that saphenous vein may become aneurysmal. Currently there are few case reports regarding outcomes of infrainguinal arterial reconstructions and follow-up has been very short-term. We report a rare case of successful repair of a popliteal aneurysm using a saphenous vein graft in a patient with Marfan Syndrome.
Methods
This patient is a 59-year old male with Marfan Syndrome. He presented with acute onset of painful, pre-gangrenous toes. A monophasic Doppler signal was present in both pedal arteries. CT angiography (CTA) demonstrated a completely thrombosed, 2cm left popliteal artery aneurysm with tibial artery reconstitution. Vein mapping demonstrated non-aneurysmal 4.3mm greater saphenous veins bilaterally.
Results
Repair of this aneurysm was performed with a left superficial femoral to below-knee popliteal artery bypass using an ipsilateral, reversed saphenous vein graft. The aneurysm was ligated proximally and distally. Postoperatively, the distal pulses were easily palpable. The patient had no perioperative complications. His foot pain resolved, and the pre-gangrenous changes in the toes resolved. At 27 months of follow-up, ultrasound of the vein graft revealed it was widely patent with no aneurysmal degeneration.
Conclusions
In this limited experience, saphenous vein is a feasible, safe graft for repair of popliteal aneurysms in patients with Marfan Syndrome.
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