Chronic Limb‐Threatening Ischemia Owing to Popliteal Artery Aneurysms With Repeated Occlusion After Stent Graft Placement That was Successfully Treated With Supera Stent Reinforcement: A Case Report

Popliteal artery aneurysms (PAAs) can cause serious symptoms and are difficult to treat. Endovascular PAA repair (EPAR) using stent grafts (SGs) has demonstrated favorable clinical outcomes for treating PAAs. However, tortuous arteries and huge PAAs may result in distortion of SGs, which may cause re-occlusion of the revascularized vessels. This report describes the successful use of EPAR to treat PAA and the use of lining Supera stents to deal with bent SGs. A 55-year-old woman with mixed connective tissue disease, antiphospholipid antibody syndrome, and chronic deep venous thrombosis presented with an ulcer on the right toe. Computed tomography revealed bilateral PAAs and occlusion from the right popliteal artery to all below-the-knee (BTK) arteries. EPAR was performed and two SGs were deployed for the PAAs. The BTK occlusion was treated using intravascular ultrasound-guided wiring. However, the SGs occluded within 2 weeks. A massive thrombus was aspirated using the Indigo system (CAT8; Asahi Intecc Co. Aichi, Japan), and catheter-directed thrombolysis was initiated owing to the large size of the thrombus. However, the SGs became occluded within 2 days. Aspiration was performed, and the Supera stent was deployed at the distal edge of the restenosis. The BTK runoff was recanalized, and catheter-directed thrombolysis was continued. However, the BTK runoff occluded the following day. Aspiration was performed, and the Eluvia stent was deployed at the proximal edge of the restenosis. The BTK runoff was recanalized and stayed open. An additional treatment was conducted 2 months later using an inline Supera stent to straighten the bent Viabahn SG and ensure the BTK flow. The ulcer fully healed after this procedure. Using the Supera stent to line and straighten the SG to obtain enhanced blood flow may facilitate improved management following EPAR of PAA.