Cor Vasa 2015, 57(5):e366-e370 | DOI: 10.1016/j.crvasa.2015.05.004

Treatment of symptomatic popliteal artery aneurysms with venous bypass by the AESA (asymmetric end-to-end spatulated anastomosis) technique

Georgios A. Pitoulias^a,*, Konstantinos P. Donas^b, Theodosios Bisdas^b, Konstantinos Stavroulakis^b, Dimitrios C. Christopoulos^a

^a Second Surgical Department, Division of Vascular Surgery, Aristotle University of Thessaloniki, "G. Gennimatas" Thessaloniki Hospital, Thessaloniki, Greece

^b Clinic for Vascular and Endovascular Surgery, Münster University Hospital and St. Franziskus Hospital, Münster, Germany

We report 6 cases of critical limb ischemia in 4 patients due to symptomatic popliteal artery aneurysm and we present the AESA (asymmetric end-to-end spatulated anastomosis) technique for use in autologous vein bypasses in crural vessels. This is a modified technique of conventional end-to-end spatulated anastomosis, which results in an asymmetric configuration of the anastomotic lateral walls. Using this modified technique the anastomosis' area is greater and the opposite lateral anastomotic sites are always at different inclined levels. Therefore, in cases of intimal hyperplasia formation this asymmetric configuration may avoid the marked stenosis of the anastomosis and consequently the procedure's failure. In all cases, the asymmetric end-to-end anastomosis was used for revascularization of a single patent crural vessel. All procedures were successful and all target vessels remain patent for a median follow up of 15 months so far.

Keywords: Asymmetric peripheral anastomosis; Autologous venous graft; Graft patency; Intimal hyperplasia; Myointimal hyperplasia

Received: February 18, 2015; Revised: April 22, 2015; Accepted: May 4, 2015; Published: October 1, 2015  Show citation