Endovascular Treatment of Crural Aneurysms: Case Report and Systematic Review Regarding Indication, Stent Characteristics and Patency

Background: We present our experience with the endovascular therapy (EVT) of a pseudo-aneurysm of the posterior tibial artery (PTA) with an associated arteriovenous fistula (AVF) and a systematic review was carried out to put a light on the EVT. Methods: A 31-year-old patient presented with pain in the lower leg with increasing severity and a history of war trauma. A CT-Angiogram confirmed an aneurysm of the PTA with an AVF. With a bidirectional endovascular approach, the aneurysm was occluded with Coils and excluded with a Viabahn Endoprosthesis. Aspirin and Clopidogrel were recommended postoperatively. After 18 months of follow-up, the patient is free of symptoms with patent endoprosthesis. Multiple databases (Scopus, Pubmed, Medline, OVID) were systematically searched with MeSH terms. The studies were scrutinized and data on demographics, procedural details, and follow-up was collected and pooled. Results: A total of 44 studies (56 patients) were eligible and included. Average age was 50 (15-87 years). The most common etiology was trauma (iatrogenic 29/56;51.7% and non-iatrogenic 15/56;26.7%). EVT strategies included coil-embolization (n=29), stent-implantation (n=25), and a combination of both (n= 2). Median stent diameter was 3mm (2.5–6). The follow-up period ranged from 1week-60 months. Primary Patency was 18/27 (66.6%) with no reported complications. Conclusion: EVT offers a feasible and safe alternative to simple ligation or occlusion of crural aneurysms to preserve distal flow to the foot. Dedicated stents for crural arteries are not available. Studies with long-term follow-up are lacking.