The recent advance in the management of popliteal artery aneurysm (PAA) included placement of stented grafts. The precision of proximal and distal graft placement under fluoroscopic guidance becomes challenging in presence of mural PAA thrombus. Our experience with ultrasound guidance for infrainguinal interventions encouraged us to apply it for stented grafts placement.

An 82 year old male with PMHx of right nephrectomy for cancer, CAD s/p PTCA and stents, HTN, BPH, hypercholesterolemia, CVA, s/p open cholecystectomy, s/p exploratory laparotomy presented to vascular surgery office with pulsatile mass behind the left knee. Asymptomatic popliteal artery aneurysm measuring 3.15 cm by duplex was found behind the knee in left leg. There was significant amount of mural thrombus in the aneurysm (up to 18 mm thick with residual arterial lumen 5-10 mm).

An 8 mm in diameter and 10 cm length Viabahn stented graft was successfully placed transcutaneously (via 10Fr sheaths in the ipsilateral common femoral artery) under local anesthesia under duplex-guidance alone. Distal graft edge was precisely parked in PA 2 cm beyond the aneurysm end below-the-knee.

Endovascular repair of popliteal artery aneurysm with Viabahn stented graft can be performed under duplex guidance alone. This treatment option can be particularly beneficial in patients with renal failure.